Researchers published the case report of a patient with granulomatosis with polyangiitis (GPA), an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), that presented as chest pain in the journal Cureus.
A 57-year-old man presented to the emergency department for midsternal chest pain radiating to his left arm. The pain started at rest and was described as a 6/10 in intensity, lasting for around 15 minutes. The placement of a Nitro patch eventually relieved the pain.
The patient’s past medical history was notable for hypertension, hyperlipidemia, gastroesophageal reflux disease, and degenerative joint disease. He also had a 30 pack-year smoking history and was diagnosed with emphysema. Two weeks previous, he had his annual physical check-up and was diagnosed with acute renal failure (creatinine, 2.0 mg/dL). His physicians advised him to stop taking meloxicam and aspirin.
Upon admission to the emergency department, the patient’s troponin levels were 0.268, which elevated to 5.006. His physicians decided that he was most likely suffering from a non-ST elevated myocardial infarction (NSTEMI). He was prescribed intravenous fluids and N-acetylcysteine with percutaneous coronary intervention twice. The patient then underwent left heart catheterization under the working diagnosis of NSTEMI.
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Laboratory investigations revealed a slightly elevated white blood count, low hemoglobin, and an abnormal renal profile. He was also positive for ANCA.
A renal biopsy was performed, revealing 1+ segmental granular mesangial and capillary loop staining near a section of sclerosis at the glomerulus for immunoglobulin (Ig) G, IgA, and IgM. In addition, 2 glomeruli were observed to have fibrocellular crescents. These findings, together with ANCA positivity, were characteristic of pauci-immune necrotizing crescentic glomerulonephritis.
The patient was started on intravenous cyclophosphamide, which resulted in improvements in his kidney function parameters. He was discharged with a maintenance dose of azathioprine and continued to be followed-up at a nephrology clinic.
“It is beneficial to include GPA in the differential diagnosis for patients presenting with chest pain and include immunological tests like ANCA earlier in the workup for early diagnosis and treatment of GPA, which could result in better treatment outcomes,” the authors concluded.
Fentie K, Singanamala S, Hozayen O, Altaf L. Granulomatosis with polyangiitis presenting as chest pain: a case report. Cureus. Published online April 27, 2023. doi:10.7759/cureus.38204