Insidious coronary artery disease in a young patient with polyarteritis nodosa: a case report and literature review

BACKGROUND: Polyarteritis nodosa (PAN) is a relatively rare systemic necrotizing vasculitis that typically affects medium-sized arteries. Although myocardial ischemia may occur due to involvement of the coronary arteries, overt myocardial infarction is uncommon. Case presentation A 22-year-old Chinese man experiencing chest pain for 7 months was admitted to our hospital. Consistently, the pain tended to last for a few minutes and then spontaneously subside. He had 7-year history of “stable” PAN. Coronary angiography revealed slight plaque infiltration of the left main coronary artery; however occlusion of all the three major coronary arteries with multiple aneurysms. A stent was implanted into the obtuse margin branch artery which was 95% stenosis, and then the chest pain was alleviated. Considering that the occlusion of coronary arteries was due to insidious vasculitis, prednisone 50 mg/day and methotrexate 15 mg/week were reinitiated, in combination with anti-angina medications. CONCLUSIONS: We report a young patient with insidious occlusion of three main coronary arteries under the circumstance of stable PAN for 7 years, suggesting the necessity of assessing the heart, in spite of normal acute phase reactants. The appropriate screening strategy needs to be studied.