An Unusual Presentation of Granulomatosis with Polyangiitis Diagnosed After Cardiac Tamponade

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Üsküdar A., Meral E. A., Erata M. G., Adam U.F.Turk A. U., Şentürk B.

41. Ulusal Kardiyoloji Kongresi, Antalya, Türkiye, 13 - 16 Kasım 2025, ss.1-2, (Özet Bildiri)

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: Antalya
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.1-2
  • Dokuz Eylül Üniversitesi Adresli: Evet

Özet

Background

Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis that typically involves the upper respiratory tract, lungs, and kidneys. Cardiac involvement is rare and cardiac

tamponade is an exceptionally uncommon initial manifestation. In this case, we present a young male patient who was admitted with cardiac tamponade and was subsequently

diagnosed with GPA.

Case Report

A 35-year-old male with no known chronic illness presented to the emergency department with palpitations. His medical history included effusion-related otitis media diagnosed 2.5

months prior and eustachian tube dysfunction. He had a 20 pack-year smoking history. Electrocardiography revealed sinus tachycardia at 110 bpm.

Transthoracic echocardiography showed 2.0 cm pericardial effusion adjacent to the posterior wall, 1.9 cm near the lateral wall and 1.4 cm anterior to the right ventricle.

Due to signs of cardiac tamponade, emergent pericardiocentesis was performed, and 400 cc of exudative pericardial fluid was drained. The fluid was exudative by Light's criteria;

culture and cytology were negative.

Laboratory tests revealed elevated inflammatory markers and positive PR3-ANCA.

ENT evaluation of the nasopharynx showed “cobblestone appearance” of the mucosa.

According to the 2022 EULAR classification criteria, a diagnosis of Granulomatosis with Polyangiitis (GPA) was established.

Discussion

Cardiac involvement in GPA is rare and often subclinical. Pericardial effusion and tamponade are particularly unusual presentations. This case highlights the importance of considering

systemic vasculitis in the differential diagnosis of cardiac tamponade, especially in patients with suggestive ENT findings and positive ANCA serology. The application of the EULAR

classification algorithm was crucial in reaching the diagnosis.

CONCLUSION: In patients presenting with cardiac tamponade, systemic autoimmune diseases such as GPA should be considered in the differential diagnosis. Early recognition of

vasculitis with atypical presentations can be life-saving.