At the heart of the matter: The exceptional case of coronary artery disease in a young man

Abstract

Causes of coronary artery vasculitis in young adults, asreported in the literature, are mainly systemic inflamma-tory diseases like Takayasu disease (1), systemic lupuserythematosus (2), rheumatoid arthritis (3), polyarteritisnodosa (4), and Churg-Strauss syndrome (5). Other re-ported causes of arteriopathy in young persons includeBehc¸et’s disease (6), sarcoidosis (7), drugs (8), and infec-tions (9). In older persons, coronary arteritis may occur inassociation with giant cell arteritis (GCA) (10). Diagnosisof coronary arteritis may be elusive when initially evalu-ating patients with large- or medium-vessel vasculitis. It iseven more unusual to diagnose vasculitis localized specif-ically to a vascular bed such as the coronary and internalmammary arteries in the absence of a systemic inflamma-tory disorder. Here, we report a case of a patient withcoronary ischemia who had coronary angiographic find-ings of premature atherosclerosis and in whom lympho-plasmacytic arteritis was found, affecting the coronary andinternal mammary vessels. To our knowledge, this is thefirst report of medium-vessel vasculitis clinically limitedto the coronary and internal mammary arteries with noassociated systemic inflammatory disease.