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GPA-Induced Granulomatous Endocarditis Mimicking a Thrombotic Mitral Valve Stenosis

Christoph Marquetand1, Peter Lamprecht2, Franz F Dressler3

  • 1Department of Cardiology, Angiology and Intensive Care, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.

JACC. Case Reports
|July 28, 2021
PubMed

Insights

Granulomatosis with polyangiitis can cause granulomatous endocarditis, leading to severe mitral valve stenosis. This rare complication may be mistaken for infectious endocarditis or thrombotic lesions.

Area of Science:

  • Cardiology
  • Rheumatology
  • Pathology

Background:

  • Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis affecting small and medium-sized vessels.
  • Cardiac involvement in GPA is uncommon, with endocarditis being a particularly rare manifestation.
  • Early recognition of cardiac complications is crucial for patient management.

Observation:

  • A case study of a patient presenting with severe mitral valve stenosis.
  • The stenosis was identified as being caused by granulomatous endocarditis.
  • The underlying condition was diagnosed as granulomatosis with polyangiitis.

Findings:

  • Granulomatous endocarditis is a rare but significant complication of granulomatosis with polyangiitis.
  • This condition can lead to severe valvular dysfunction, specifically mitral valve stenosis.
  • The presentation can mimic other cardiac pathologies, including infectious endocarditis and thrombotic lesions.

Implications:

  • Highlights the importance of considering GPA in patients with unexplained endocarditis and valvular disease.
  • Suggests the need for a high index of suspicion for GPA in cases of non-infectious endocarditis.
  • Emphasizes the potential for GPA to affect cardiac structures, necessitating comprehensive diagnostic approaches.
Keywords:
ANCA, anti-neutrophil cytoplasmic antibodyGPA, granulomatosis with polyangiitisIE, infectious endocarditisMPO, myeloperoxidaseMV, mitral valveTEE, transesophageal echocardiographyautoimmuneechocardiographyendocarditismitral valvestenosisthrombosis

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