Coronary vasculitis in granulomatosis with polyangiitis

Cardiac involvement in GPA is rare and different manifestations are described such as pericarditis, valvular lesions, coronary arteritis, myocarditis and cardiac rhythm disorders. We described a young woman, with a previous diagnosis of GPA, who has been subjected to coronography after a positive cardiac stress test. Clinical manifestation of angina or myocardial infarction could be rare in patients with GPA, but fatalmyocardial infarction may occur. In our patient, symptoms and a history of hypertension, vasculitis and cerebral vascular disease could raise the suspicion of cardiac involvement. In fact the subsequent cardiac ultrasound revealed an impaired kinetics and dobutamin stress test induced a constrictive pain, due to severe stenosis of anterior descending coronary artery. This case suggests that provocative test might be useful to early detect cardiac involvement and might prevent the onset of serious consequences.