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Patients with suspected GPA should be assessed for cardiac involvement

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DESTIN, Fla. — It is important for rheumatologists to assess for possible cardiac manifestations among patients with suspected granulomatosis with polyangiitis, according to Syed Mansour Haque, MBBS, of Creighton University in Omaha, Nebraska.

“Patients with GPA should also be looked at for other presentations apart from their typical presentation, especially cardiac involvement,” Haque told Healio Rheumatology. “We need to do certain investigations, like a cardiac MRI, which could be extremely beneficial in diagnosing patients with GPA.”

Haque and colleagues had presented a case study, in which a 47-year-old male with no significant past medical history arrived at the hospital with non-productive cough, fevers, chills and generalized body aches that began four weeks prior. He was previously treated with levofloxacin for pneumonia without any symptom improvement. Further evaluation revealed arthralgias, hyperemia of the right sclera and diminished breath sounds on auscultation with expiratory wheezes and tachycardia with a friction rub.

In addition, following an echocardiogram, it was found that the patient had sinus tachycardia with diffuse ST-segment elevation.

“This actually led us to thinking that it may be something rheumatological, because it was affecting many organs of the body,” Haque said. “Not only the eyes, but also the joints and the heart.”

According to Haque, the patient was ANA-positive, and rheumatoid factor- and anti-ds-DNA–negative, with a c-ANCA titer of 1:320 and a serine protease-3 IgG titer greater than 8.

“This led us to diagnose this patient with GPA,” he said. “However, this was a very atypical presentation, so we did a bronchoscopy, and we took a biopsy, which confirmed our diagnosis of GPA. We started the patient on prednisone, and he became better.”

Reference:

Haque SM. A curious case of myo-pericarditis in granulomatosis with polyangiitis. Presented at: Congress of Clinical Rheumatology; May 2-5, 2019; Destin, Fla.

Disclosure: Haque reports no relevant financial disclosures.