A Case of Microscopic Polyangiitis with Giant Coronary Aneurysm: Figure 1.

Abstract

To the Editor: Microscopic polyangiitis (MPA) is the most common myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated small-vessel vasculitis, with few or no immune deposits in the involved vessels. MPA always affects small vessels (capillaries, venules, arterioles) but medium-size vessels can sometimes be involved1,2. We describe a case of medium-size vessel MPA with a giant coronary aneurysm typically found in polyarteritis nodosa (PAN). To our knowledge, this is the first documented case of a giant coronary artery aneurysm in a patient with MPA. A 78-year-old woman whose previous chief complaint was chest pain and who had no history of hypertension or dyslipidemia, smoking history, or any notable family history visited a hospital because of generalized malaise in 2005. Deterioration in renal function (Cr 2.82 mg/dl) was found, but a renal biopsy yielded no definitive diagnosis. Renal failure progressed (Cr 4.65 mg/dl) and a renal biopsy was repeated in 2006 because of high MPO-ANCA titer (258 EU). On the basis of the biopsy, crescentic nephritis (ANCA-associated nephritis) was diagnosed. However, steroid … Address correspondence to Dr. H. Kobayashi, Division of Rheumatology, Itabashi Chuo Medical Center, 2-12-7 Azusawa Itabashiku, Tokyo, 1740051, Japan. E-mail: haraoka{at}pero.name