A case of aortic and mitral valve involvement in granulomatosis with polyangiitis

Espitia, O.; Droy, Laure; Pattier, Sabine; Naudin, F.; Mugniot, Antoine; Cavaillès, Arnaud; Hamidou, M.; Bruneval, Patrick; Agard, C.; Toquet, Claire

doi:10.1016/j.carpath.2014.07.007

Cited by 14 publications

(9 citation statements)

References 5 publications

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“…Mitral and tricuspid regurgitation are the most commonly reported forms of valve dysfunction in patients with EGPA, but are infrequently observed 8–17. Large valvular vegetations have been described in the idiopathic hypereosinophilic syndrome and with vasculitides such as Wegener’s granulomatosis 15 24–26. To our knowledge this case is the first description of non-infectious valvular vegetations in a patient with EGPA.…”

Section: Discussionmentioning

confidence: 74%

Non-infectious aortic and mitral valve vegetations in a patient with eosinophilic granulomatosis with polyangiitis

Karthikeyan¹,

Balla

Alpert

2019

BMJ Case Rep

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Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of vasculitis characterised by atopic manifestations, inflammation of small-sized to medium-sized arteries and veins, hypereosinophilia and tissue infiltration with eosinophils. Cardiac complications occur most commonly in the absence of antineutrophil cytoplasmic antibodies. Cardiac complications include coronary arteritis (rare), pericarditis, myocarditis, endocardial fibrosis (Loeffler’s endocarditis) and intracavitary thrombosis of the left or right ventricle. This is the first reported case of large non-infectious valvular vegetations associated with EGPA.

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Section: Discussionmentioning

confidence: 74%

Non-infectious aortic and mitral valve vegetations in a patient with eosinophilic granulomatosis with polyangiitis

Karthikeyan¹,

Balla

Alpert

2019

BMJ Case Rep

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“…In this case the lesion increased in size despite immunosuppressant and steroid treatment, and finally the patient underwent mitral valve replacement with a mechanical prosthesis implantation [37]. Espitia et al [38] reported the case of a 60-year-old woman with severe inflammatory aortic and mitral valvular involvement with histopathological valvular lesions typical for GPA, which at presentation misleadingly suggest infectious endocarditis. Myocarditis is a rare condition due to GPA.…”

Section: Hypocomplementemic Urticarial Vasculitis (Huv) (Anti-c1q Vasmentioning

confidence: 86%

Cardiac manifestations in antineutrophil cytoplasmic autoantibody (ANCA) — associated vasculitides

Życińska

Borowiec

2016

Kardiol Pol

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“…In a large retrospective cohort study analyzing the frequency of cardiac involvement in GPA, pericarditis was present in 35% of GPA patients with cardiac manifestations, followed by cardiomyopathy (30%), coronary artery disease (12%), and valvular disease (6%) [5]. Valvular disease in GPA most frequently involves the aortic valve, causing vegetations and regurgitation which can clinically resemble infective endocarditis [37,38]. It has been proposed that apparent vegetations occur secondary to granulomatous inflammation of the valve resulting in myxoid degeneration [39].…”

Section: Discussionmentioning

confidence: 99%

Explosive Granulomatosis with Polyangiitis Mimicking Infective Endocarditis

Shue¹,

Chow²,

Cohen³

et al. 2019

Intern Med

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Background: Granulomatosis with polyangiitis (GPA) is a rare systemic disease that causes necrotizing granulomatous inflammation of small-and medium-sized blood vessels. Infective endocarditis (IE), which is a disease due to infection of the innermost surface of the heart, is pathophysiologically distinct from GPA and yet these two entities can manifest in strikingly similar ways. Case presentation: We report a case of a 46-year-old male whose presentation and history were strikingly suggestive of IE but was ultimately diagnosed with GPA. Originally, he presented with fever, oral ulcers, and purpuric lesions on the extremities. The patient had a history of illicit drug use and had recently undergone a dental procedure one week prior to presentation, which were classic risk factors for IE. His fever and respiratory difficulty were unresponsive to antibiotic therapy. His respiratory and renal status declined explosively during his hospitalization, requiring intubation and intensive level care. His clinical progression, negative blood cultures, and a positive c-ANCA screen prompted a workup that was more consistent with GPA. Administration of anti-inflammatory medications and plasmapheresis eventually lead to the resolution of his symptoms. Because of his precipitous pulmonary decline, his outcome would have been poor if the correct diagnosis of GPA were to have been overlooked. Conclusions: ANCA-associated vasculitis and infective endocarditis can demonstrate similar clinical findings, including in the skin. Overlap in serologic markers and other organ involvement can lead to difficulty in distinguishing these two diseases, which require contrasting treatment methods. We highlight and compare the similarities and differences between GPA and IE in discussion of this interesting case to emphasize the importance of being clinically vigilant in differentiating these two separate disease processes.

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A case of aortic and mitral valve involvement in granulomatosis with polyangiitis

Cited by 14 publications

References 5 publications

Non-infectious aortic and mitral valve vegetations in a patient with eosinophilic granulomatosis with polyangiitis

Non-infectious aortic and mitral valve vegetations in a patient with eosinophilic granulomatosis with polyangiitis

Cardiac manifestations in antineutrophil cytoplasmic autoantibody (ANCA) — associated vasculitides

Explosive Granulomatosis with Polyangiitis Mimicking Infective Endocarditis

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