Vasculitis Beyond the Kidneys

Introduction: Coronary vasculitis in patients with ANCA associated vas- culitides is underestimated and occurs most frequently in Granulomatosis with Pol- yangiitis. The objective was to review the outcome of patients treated for coronary vasculitis under our care. Methods: We retrospectively reviewed the management and outcome on all patients with ANCA associated vasculitis and coronary involvement under nephrology follow up at Universiti Kebangsaan Malaysia Medical Centre between 2008 and 2013. These pa- tients were referred to us for renal involvement of their systemic vasculitides. Results: Three out of 13 the patients with ANCA associated vasculitides developed coronary vasculitis. These patients (2 males: 1 female), aged 37, 48 and 57 years old developed coro- nary vasculitis at least 3 months from the initial presentation of systemic vasculitides. Although all pa- tients developed coronary vasculitis after receiving immunosuppressive treatment, therapy was limited by concurrent/preceding infections. Coronary vasculitis was diagnosed based on ECG changes, elevated cardiac biomarkers and echocardiogram findings with evidence of active vasculitis as supported by in- flammatory markers and auto antibodies. All three patients died either due to a coronary event or over- whelming infection secondary to immunosuppressive therapy. Conclusion: Coronary vasculitis is underreporrted in pateints with ANCA associated vasculitis. Early recognition and treatment are crucial as it carries a high cardiovascular morbidity and mortality.