Beyond the Kidneys: Cardiac Involvement in Anca Vasculitis

Introduction: ANCA-associated vasculitis (AAV) is an autoimmune disease primarily affecting the kidneys and lungs; however, cardiac involvement, though rare, can present a significant diagnostic challenge. This complication is often underestimated and may manifest as myocarditis or heart failure, necessitating a thorough cardiological assessment. Diagnosis relies on echocardiography and advanced imaging techniques, while therapeutic management involves a combination of corticosteroids and immunosuppressants.

Aim: This case report highlights the importance of rigorous cardiac monitoring in this systemic disease.

Case Report: We report the case of a 40-year-old patient with seronegative ANCA-associated vasculitis complicated by severe renal insufficiency, previously treated with corticosteroids and immunosuppressants. The patient presented with worsening chronic dyspnea, episodes of hemoptysis, and a deterioration of general health status.

Investigations revealed severe anemia, acute renal failure, and signs of alveolar hemorrhage on thoracic imaging. Cardiac assessment demonstrated a dilated hypokinetic cardiomyopathy with severe left ventricular dysfunction (LVEF of 36%), without evidence of right heart failure.

The patient was managed with emergency hemodialysis, blood transfusion, corticosteroid therapy, and methotrexate, in addition to heart failure treatment with beta-blockers and angiotensin-converting enzyme inhibitors (ACEIs). A significant improvement in cardiac function was observed at the three-month follow-up, with an LVEF of 45-50%.

Discussion and Conclusion: Cardiac involvement in ANCA-associated vasculitis is a rare but serious complication that requires early detection and a multidisciplinary approach. This case emphasizes the importance of systematic cardiac monitoring to improve patient prognosis. Echocardiographic evaluation and treatment with corticosteroids and immunosuppressants resulted in significant clinical improvement, highlighting the need for an appropriate diagnostic and therapeutic strategy.