Direct percutaneous coronary intervention for NSTEMI in a patient with seropositive Wegener's granulomatosis

A case of a 49-year-old man who presented with symptoms of generalized classical Wegener's granulomatosis with the exceptional complication of acute non-ST-elevation myocardial infarction (NSTEMI) is reported. Coronary arteriography revealed an extensive arteriitis with multilocal stenosis of the left anterior descending coronary artery. The culprit lesion was treated by stent implantation with success while immunosuppressive treatment with cyclophosphamide and prednisolone was continued. Using arteriography, 4 months later we found normal coronary arteries without manifestation of vasculitis. Within 8 months of medical treatment complete remission was achieved and therapy was changed to low-dose methotrexate once a week. Meanwhile medical treatment has been stopped entirely. The patient is in good clinical condition. This case indicates that the adverse event of coronary vasculitis in any patient suffering from primary or secondary vasculitis can occur. Clinically significant myocardial ischemia can occur and can even lead to myocardial infarction.