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This biopsy of a gastrocnemius muscle in another patient, a 69-year-old man with MPA depicts diagnostic changes of intense inflammatory infiltrate and destruction of the blood vessel wall within the muscle.
Source publication
The potential etiologies of third-degree complete heart block include idiopathic, pathologic, and iatrogenic causes. We present a rare case of complete heart block in an elderly woman with microscopic polyangiitis (MPA), who presented with dyspnea on exertion and dizziness.
Context in source publication
Context 1
... these conditions poses a significant challenge as the clinical presentation can be similar to malignancy or infection. The common underlying pathology in these diseases is small vessel vasculitis leading to necrosis similar to Figure 2 [2]. Colin et al. presented a case of GPA with endocarditis, pericarditis, myocardial infarction, and atrioventricular block due to infiltration causing a mass to form in the interatrial septum [3]. ...
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The association between ANCA-associated vasculitis and hematologic malignancy has been previously described and remains a rare phenomenon, albeit potentially underdiagnosed. We report the case of an 81-year-old patient with myelodysplastic syndrome who was managed for an infectious-appearing pneumonia, which subsequently complicated into complete h...
The association between ANCA-associated vasculitis and hematologic malignancy has been previously described and remains a rare phenomenon, albeit potentially underdiagnosed. We report the case of an 81-year-old patient with myelodysplastic syndrome who was managed for an infectious-appearing pneumonia, which subsequently complicated into complete h...
Citations
... Autopsy findings in some cases showed infarctions of the atrioventricular node or bundle of His and arteritis of the supplying arteries, along with one instance of granulomas in the interventricular septum [9,10]. Overall, complete AVB cases are considered exceptional in MPA, with only one reported case so far occurring in an elderly patient with multiple cardiovascular comorbidities [11]. In the presented case, AVB onset coincided with the MPA diagnosis during the active inflammatory phase of the disease. ...
The association between antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and hematologic malignancy has been previously described and remains a rare phenomenon (although potentially underdiagnosed). We report the case of an 81-year-old patient with myelodysplastic syndrome who was managed for an infectious-appearing pneumonia, which subsequently complicated into complete heart block and severe acute respiratory distress syndrome with a fatal outcome. The final diagnosis is severe hemorrhagic alveolitis due to ANCA-associated vasculitis meeting the criteria for microscopic polyangiitis. This article provides an opportunity to discuss the association between ANCA-associated vasculitis and hematologic malignancies and the adverse prognosis associated with it.
... From literary sources, it is known about an unusual picture of MPA associated with pleuropericarditis, pulmonary embolism and pulmonary bleeding as a complication of silicosis [88], ANCA-negative MPA with DAH masquerading as congestive heart failure [132], a case of MPA associated with aortic valve insufficiency [133] and aortic stenosis [134]. A rare case of complete heart block was reported in an elderly woman with MPA who presented with dyspnea on exertion and dizziness [135]. ...
Microscopic polyangiitis (MPA) is an important new medical problem, as it shows increasing incidence and prevalence in the population, especially after the outbreak of coronavirus disease 2019 (COVID-19). MPA is a multisystemic destructive disease with a wide spectrum of heterogeneous clinical manifestations depending on the affected organs. The polymorphism of nonspecific clinical signs and the variability of the clinical picture, which differs from patient to patient, can cause a diagnostic delay and establish the correct diagnosis only in the late stages of the disease. That is why many patients consult and receive treatment from different doctors before verifying the diagnosis. In the review article, an analysis of literary sources was made, which highlighted classic renal and/or pulmonary symptoms, skin, gastrointestinal, neurological and cardiovascular manifestations of MPA. It is important to note that the clinical manifestations of MPA can be very different from the usual recognized patterns and manifest as unusual manifestations of the disease with a hidden or atypical course, and therefore received the figurative name “the Great Masquerades”. So MPA can often hide under the “mask” of other diseases, including COVID-19 itself, which significantly complicates its early diagnosis and treatment. That is why doctors should be better informed about the different variants of the clinical course of MPA and approaches to diagnosis, which will help eliminate delays in diagnosis. After all, the rapid diagnosis of MPA is important for the initiation of adequate immunosuppressive therapy, which can both save lives, preserve organs from damage, and improve the quality of life.
... Autopsy ndings in some cases showed infarctions of the atrioventricular node or bundle of His and arteritis of the supplying arteries, along with one instance of granulomas in the interventricular septum [9,10]. Complete AVB cases are uncommon in MPA, with only one reported case occurring in an elderly patient with multiple cardiovascular comorbidities, diagnosed eight months after MPA diagnosis [11]. In the presented case, AVB onset coincided with the MPA diagnosis during the active in ammatory phase of the disease. ...
The association between ANCA-associated vasculitis and hematologic malignancy has been previously described and remains a rare phenomenon, albeit potentially underdiagnosed. We report the case of an 81-year-old patient with myelodysplastic syndrome who was managed for an infectious-appearing pneumonia, which subsequently complicated into complete heart block and severe acute respiratory distress syndrome with a fatal outcome. The final diagnosis is severe hemorrhagic alveolitis associated with ANCA-associated vasculitis meeting the criteria for microscopic polyangiitis. This article provides an opportunity to discuss the association between ANCA-associated vasculitis and hematologic malignancies and the adverse prognosis associated with it.
... Autopsy ndings in some cases showed infarctions of the atrioventricular node or bundle of His and arteritis of the supplying arteries, along with one instance of granulomas in the interventricular septum [9,10]. Complete AVB cases are uncommon in MPA, with only one reported case occurring in an elderly patient with multiple cardiovascular comorbidities, diagnosed eight months after MPA diagnosis [11]. In the presented case, AVB onset coincided with the MPA diagnosis during the active in ammatory phase of the disease. ...
The association between ANCA-associated vasculitis and hematologic malignancy has been previously described and remains a rare phenomenon, albeit potentially underdiagnosed. We report the case of an 81-year-old patient with myelodysplastic syndrome who was managed for an infectious-appearing pneumonia, which subsequently complicated into complete heart block and severe acute respiratory distress syndrome with a fatal outcome. The final diagnosis is severe hemorrhagic alveolitis associated with ANCA-associated vasculitis meeting the criteria for microscopic polyangiitis. This article provides an opportunity to discuss the association between ANCA-associated vasculitis and hematologic malignancies and the adverse prognosis associated with it.
... A 77-year-old Caucasian female was diagnosed with a complete heart block caused by MPA, according to a case report published by Filice et al. [97]. It was attributed to coronary artery necrosis due to vasculitis. ...
Systemic vasculitides encompass a cluster of autoimmune diseases that affect blood vessels, and are characterized by immune-mediated injury to either small- or large-sized blood vessels. Individuals afflicted with systemic vasculitides experience notable morbidity and mortality attributable to cardiovascular manifestations. Noteworthy among these are ischemic heart disease, venous thromboembolism, aortic involvement, valvular irregularities, myocarditis, and pericarditis. This narrative review investigated and evaluated the prevalent cardiovascular disturbances commonly associated with different types of vasculitides. This review also discusses the mechanisms that underlie these manifestations. It also provides a thorough explanation of the many diagnostic techniques essential for detecting the disease at its occult stage. It is essential for healthcare professionals to have knowledge of the cardiovascular complications caused by vasculitides, as this enables them to promptly recognize these symptoms and employ suitable diagnostic techniques early on. By doing so, timely detection can be ensured, which will subsequently aid in initiating appropriate treatment strategies that are vital for decreasing morbidity and mortality in patients with systemic vasculitides.
