Coronary Polyarteritis Nodosa: Clinical Dilemmas in Diagnosis and Management.

CLINICAL CONDITIONS: A 43-year-old woman presented with multiple coronary vascular wall irregularities, triple-vessel segmental stenosis, coronary aneurysmal dilatation, and coronary collateral arteries. She was diagnosed with polyarteritis nodosa (PAN) with coronary involvement.

KEY QUESTIONS: What is the approach of management for coronary PAN? What role does a multidisciplinary approach play in optimizing the management and outcomes of patients with coronary PAN?

OUTCOMES: The patient was treated with aggressive immunotherapy, including high-dose corticosteroids, mycophenolate, and later rituximab, to control inflammation and prevent vascular damage. Antithrombotic therapy (clopidogrel and rivaroxaban) and cardiovascular risk factor management (statins, angiotensin-converting enzyme inhibitors, and smoking cessation) were initiated. Although coronary artery bypass graft was considered because of triple-vessel disease, it was deferred as the patient remained stable. Regular follow-up demonstrated symptomatic improvement.

TAKE-HOME MESSAGES: Coronary PAN requires a multidisciplinary approach for diagnosis and management. Medical therapy often takes precedence, with surgical interventions reserved for selected cases.