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Pathologic Evidence of Granulomatosis With Polyangiitis as a Cause of Atrioventricular Block
Naoki Watanabe1, Kenji Harada2, Shigeo Kawai3
1Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan; Department of Cardiology, Tochigi Medical Center Shimotsuga, Shimotsuke, Tochigi, Japan.
Background:
Atrioventricular block (AVB) is a rare manifestation of granulomatosis with polyangiitis (GPA), and the underlying pathologic relationship between GPA and AVB remains poorly understood.
Case Summary:
We present the case of a 71-year-old woman who developed complete AVB and had a history of microscopic polyangiitis. Despite the absence of clinical signs indicative of GPA relapse throughout her lifetime, postmortem examination revealed microgranulomas and multinucleated giant cells within the atrioventricular node.
Discussion:
This case provides pathologic evidence that GPA can lead to complete heart block as an initial clinical manifestation.
Take-Home Messages:
GPA-associated AVB can improve with immunosuppressive therapy. GPA should be considered in the differential diagnosis of AVB of unknown etiology.
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