Acute ST-Segment Elevation Myocardial Infarction as the Initial Presentation of Granulomatosis with Polyangiitis: A Case Report

Granulomatosis with polyangiitis (GPA) is a rare systemic necrotizing vasculitis primarily affecting small and medium-sized vessels, classically involving the upper and lower respiratory tracts and kidneys. While cardiovascular involvement is uncommon, isolated coronary artery involvement remains exceedingly rare. Herein, we report the case of a 57-year-old male presenting with recurrent fever and dry cough. Based on clinical and serological profiles, an antineutrophil cytoplasmic antibodies-associated vasculitis was suspected, prompting a subsequent underwent lung biopsy. Shortly following this procedure, the patient developed acute chest pain. Following a comprehensive diagnostic workup, he was diagnosed with GPA complicated by acute ST-segment elevation myocardial infarction. He was urgently treated with intravenous methylprednisolone and cyclophosphamide. Within one week, the patient demonstrated dramatic symptomatic and hemodynamic improvement. This case underscores the critical importance of comprehensive cardiac evaluation in newly diagnosed GPA patients. It highlights that subclinical coronary arteritis may precede overt systemic manifestations or complications. Early recognition of such involvement is paramount for guiding appropriate immunosuppressive intervention, potentially altering the clinical course and improving prognosis.