ABSTRACT
HISTORY AND ADMISSION FINDINGS: A 49-year-old patient was admitted to our ward because of a troponin elevation (non ST-elevation myocardial infarction) following a rhinoscopy in an external hospital. The patient complained of typical angina, chronic rhinitis and epistaxis. Analysis of the nasal biopsy had shown the histological finding of granulomatosis with polyangiitis (Wegener's granulomatosis). INVESTIGATION: The consecutively performed catheterization showed a coronary one-vessel disease without significant stenosis. Echocardiography showed diastolic dysfunction as well as hemodynamically not significant pericardial effusion. The MRI scan of the heart revealed multiple myocardial scars located ventricular apical and septal. Extended bilateral pulmonary opacities in the thoracic CT scan, microhematuria, leukocyturia and proteinuria indicated multi-organ involvement of the small vessel disease. TREATMENT AND COURSE: The patient's condition improved quickly in response to steroids and cyclophosphamide, followed by attenuation of clinical symptoms and normalizing blood and renal parameters. CONCLUSION: The prognosis of granulomatosis with polyangiitis is mainly limited by renal and pulmonal involvement. Cardiac involvement is commonly rare and associated with clinical courses refractory to immunosuppressive therapy. Generally, all cardiac structures can be affected, thereby impending serious cardiac events. Normally, granulomatosis with polyangiitis responds quickly to immunosuppressive therapy, associated with a rather good prognosis without higher mortality.
Subject(s)
Acute Coronary Syndrome/etiology , Microscopic Polyangiitis/complications , Vasculitis, Central Nervous System/complications , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/drug therapy , Cyclophosphamide/therapeutic use , Humans , Male , Microscopic Polyangiitis/diagnosis , Microscopic Polyangiitis/drug therapy , Middle Aged , Steroids/therapeutic use , Treatment Outcome , Vasculitis, Central Nervous System/diagnosis , Vasculitis, Central Nervous System/drug therapyABSTRACT
HISTORY AND ADMISSION FINDINGS: A 53-year-old woman was admitted to our chest pain unit because of an acute coronary syndrome (non ST-elevation myocardial infarction). She complained of asthma, chronic sinusitis and involuntary weight loss, occasional fever and night sweats over the past six months. INVESTIGATIONS: Coronary angiography did not show any signs of macroscopic coronary artery disease, while echocardiography demonstrated a hemodynamically not significant pericardial effusion. Magnetic resonance imaging of the heart revealed a subendocardial scar, extension and localization pointing to a vascular genesis. Thoracic computed tomography revealed pulmonary opacities and blood tests showed an eosinophilia, leading to the clinical diagnosis of Churg-Strauss syndome. TREATMENT AND COURSE: The patient responded quickly to oral steroids, and blood parameters returned to normal. CONCLUSION: Acute coronary syndrome in youngish patients without classical cardiovascular risk factors is suggestive for myocarditis but also for vasculitis. Churg-Strauss syndrome usually responds quickly to immunosuppressive therapy, associated with a rather good prognosis without high mortality.
Subject(s)
Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/etiology , Churg-Strauss Syndrome/complications , Churg-Strauss Syndrome/diagnosis , Churg-Strauss Syndrome/drug therapy , Female , Humans , Middle Aged , Steroids/therapeutic use , Treatment OutcomeABSTRACT
HISTORY AND ADMISSION FINDINGS: Due to a retroperitoneal hematoma after cardiac catheterization a 64 year-old woman received two concentrates of red blood cells. Within two hours after transfusion the patient developed acute dyspnoea, anxiety and shivering. INVESTIGATIONS: Computertomography (CT) of the chest revealed a new bilateral, basally accented pulmonary edema. Pulmonary embolism was ruled out. A cardiac cause in terms of cardiogenic shock had been excluded by echocardiography and other non-invasive measurements. Moreover, no circulatory overload (transfusion-associated circulatory overload [TACO]) after transfusion was presented and the stable size of the retroperitoneal hematoma excluded haemorrhagic shock. Hence, the clinical pattern pointed towards a transfusion-related acute lung injury (TRALI). TREATMENT AND COURSE: The patient was intubated and a catecholamine medication was initiated. The weaning process proceeded without complications and the patient was extubated after several days. In the following chest x-ray no pulmonary residuals were left. After two weeks the patient was transferred to a rehabilitation unit. CONCLUSION: TRALI is a life-threatening and an often unconsidered complication after transfusion of plasma containing blood products. According to the criteria of the european haemovigilance networks (EHN-criteria), TRALI is diagnosed by clinical and radiological parameters. In case of suspicious TRALI the involved transfusion center has to be informed. By a crossmatch between donor plasma and recipient granulocytes the causal antibodies are detected in most cases. In 17% of cases no antibodies are detected.
Subject(s)
Acute Lung Injury/diagnosis , Cardiac Catheterization/adverse effects , Coronary Restenosis/therapy , Drug-Eluting Stents , Erythrocyte Transfusion/adverse effects , Hematoma/etiology , Hematoma/therapy , Myocardial Infarction/therapy , Myocardial Revascularization , Pulmonary Edema/etiology , Respiratory Insufficiency/etiology , Retroperitoneal Space , Acute Lung Injury/therapy , Catecholamines/administration & dosage , Combined Modality Therapy , Echocardiography , Female , Humans , Intermediate Care Facilities , Intubation, Intratracheal , Middle Aged , Pulmonary Edema/diagnosis , Pulmonary Edema/therapy , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/therapy , Tomography, X-Ray Computed , Ventilator WeaningABSTRACT
Two cases of formes frustes variants of Churg-Strauss syndrome are reported, who were treated with an antibody against immunoglobulin E as an addition on rescue therapy.
