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Kawahara H, Mizushima I, Matsumoto Y, Sakata K, Takamura M, Inoue D, Kasashima S, Kawano M. Solitary recurrence of IgG4-related giant coronary aneurysm: Case report and review of the literature focusing on treatment strategies and complications. Mod Rheumatol Case Rep 2023; 8:182-194. [PMID: 37947034 DOI: 10.1093/mrcr/rxad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/13/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
Coronary periarteritis is a dangerous manifestation of IgG4-related disease, because it forms coronary artery aneurysms, which may cause sudden cardiac death. We report the case of a 78-year-old woman with IgG4-related coronary periarteritis and a coronary aneurysm, which showed progressive enlargement despite maintenance therapy for Type 1 autoimmune pancreatitis. This case was unique, in that coronary periarteritis was the only active lesion that recurred. Low-dose glucocorticoids suppressed the progression of periarterial lesions but led to rapid thinning of the aneurysmal wall and an increase in the size of mural thrombi, which pose a risk of myocardial infarction. Our systematic literature review including 98 cases of 86 articles was performed to examine its treatment strategies and complications. Among the cases in which the effect of immunosuppressive therapy could be followed radiologically, 33 of 37 (89.1%) cases showed improvement in wall thickening/periarterial soft tissue, while 6 of 13 (46.2%) showed worsening increase in the outer diameter of the coronary aneurysms. We propose a draft treatment algorithm and suggest that immunosuppressive therapy for IgG4-related coronary periarteritis with coronary aneurysms should be conducted only after the therapeutic benefit has been determined to outweigh the risks. Because coronary periarteritis can occur without other organ involvement, as in our case, all cases of IgG4-related disease require careful monitoring of coronary artery lesions.
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Affiliation(s)
- Hiroyuki Kawahara
- Department of Rheumatology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Ichiro Mizushima
- Department of Rheumatology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Yasushi Matsumoto
- Department of Cardiovascular Surgery, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Kenji Sakata
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Satomi Kasashima
- Department of Clinical Laboratory Science, Kanazawa University, Kanazawa, Japan
| | - Mitsuhiro Kawano
- Department of Rheumatology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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Goudot G, Yanamandala M, Mitchell R, Tolis G, Gerhard Herman MD. Severe triple vessel disease secondary to IgG4-related coronary periarteritis. J Card Surg 2022; 37:5468-5471. [PMID: 36378869 DOI: 10.1111/jocs.17187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Immunoglobulin G4-related disease is a rare systemic inflammatory disease that can lead to vascular manifestations such as periarteritis. CASE PRESENTATION A 41-year-old man with stress angina was referred for coronary bypass surgery due to triple vessel coronary disease. CONCLUSIONS Operative findings revealed significant adhesions and dense peri-coronary and periaortic thickening, also involving the left internal mammary artery. The IgG4-associated disease was confirmed by aortic pathology. The stress angina subsequently improved with the initiation of treatment with prednisone and rituximab.
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Affiliation(s)
- Guillaume Goudot
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mounica Yanamandala
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Mitchell
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - George Tolis
- Cardiac surgery Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marie-Denise Gerhard Herman
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Lanzafame LRM, Carerj ML, Rizzo G, Minutoli F, Bucolo GM, Irrera N, Muscogiuri G, Sironi S, Blandino A, D’Angelo T. Multimodality Imaging Evaluation of Coronary IgG4-Related Disease: A "Tumor-Like" Cardiac Lesion. Diagnostics (Basel) 2022; 12:diagnostics12112814. [PMID: 36428873 PMCID: PMC9689228 DOI: 10.3390/diagnostics12112814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibro-inflammatory disorder. Coronary IgG4-RD has been scarcely reported and may present as "tumor-like" lesions. These pseudo-masses may be underdiagnosed mainly due to a vague clinical picture that can vary from complete lack of symptoms to acute coronary syndrome or sudden cardiac death. Early recognition of coronary IgG4-RD is essential to monitor disease activity and prevent life-threatening complications. We report a comprehensive non-invasive imaging evaluation of a patient affected by coronary IgG4-RD, which was diagnosed as an incidental finding during routine pre-laparoscopic cholecystectomy checkup. Non-invasive imaging revealed the presence of a peri-coronary soft-tissue mass that was stable at 12 months follow-up.
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Affiliation(s)
- Ludovica R. M. Lanzafame
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Maria Ludovica Carerj
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giovanna Rizzo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Fabio Minutoli
- Nuclear Medicine Unit, BIOMORF Department, University of Messina, 98124 Messina, Italy
| | - Giuseppe M. Bucolo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Natasha Irrera
- Pharmacology Unit, DIMED Department, University Hospital Messina, 98124 Messina, Italy
| | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, 20149 Milan, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Alfredo Blandino
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Tommaso D’Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 Rotterdam, The Netherlands
- Correspondence:
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