Cardiac Involvement in Granulomatosis With Polyangiitis (Wegener Granulomatosis)

A 38-year-old man was admitted to the emergency department with a 12-hour onset of shortness of breath and position-related chest pain. In the last 3 months, he had had 2 similar but less intense episodes, each of which lasted for approximately 1 week. Both episodes were associated with subfebrility, flulike symptoms (dry cough, nasal obstruction), and increased fatigue and resolved with nonsteroidal antiinflammatory medication. The patient was diagnosed 2 years earlier with limited Wegener granulomatosis with upper and lower respiratory tract involvement (positive for antineutrophil cytoplasmic antibodies [anti-proteinase 3], a positive sinus ethmoidalis biopsy, and no renal involvement) and was undergoing immunosuppressive therapy (azathioprine and methylprednisolone). On admission, the patient was stable and afebrile and tolerated decubitus. The clinical examination was unremarkable, with no respiratory or cardiac pathological findings on auscultation. The chest radiograph showed a normal cardiac silhouette, clear lungs, and a small left pleural effusion. The ECG performed on admission showed sinus rhythm, normal PR interval, and diffuse flattened T waves. Initial blood tests showed mild anemia (hemoglobin 12.2 mg/dL) and marked inflammation, with an elevated erythrocyte sedimentation rate (86 mm/h) and C-reactive …