Case report: Polyarteritis nodosa as a substrate for a massive myocardial infarction

Area of Science:

• Cardiology
• Rheumatology
• Pathology

Background:

• Polyarteritis nodosa (PAN) is a systemic vasculitis that can affect various organs.
• Coronary artery involvement in PAN is uncommon but can lead to severe complications.
• Pyridostigmine is a reversible acetylcholinesterase inhibitor used in conditions like myasthenia gravis.

Observation:

• A patient with known polyarteritis nodosa developed a global myocardial infarction.
• The infarction was attributed to severe coronary artery vasospasm.
• The vasospasm was a secondary effect following the administration of pyridostigmine.

Findings:

• Electrocardiography suggested multivessel coronary artery disease.
• Multimodal imaging was used to investigate differential diagnoses.
• The patient presented with cardiogenic shock requiring treatment.
• Autopsy confirmed myocardial infarction and revealed histopathological findings consistent with polyarteritis nodosa.

Implications:

• This case highlights a rare but serious adverse effect of pyridostigmine in patients with polyarteritis nodosa.
• It underscores the importance of considering medication side effects in vasculitic patients presenting with cardiac symptoms.
• The findings emphasize the need for careful patient selection and monitoring when using pyridostigmine in individuals with systemic inflammatory conditions.