A rare presentation of Henoch-Schönlein purpura and myocardial infarction at the 5th decade of life.

Henoch-Schönlein purpura is an IgA-mediated, autoimmune, hypersensitivity vasculitis of childhood that results in a triad of symptoms, including a purpuric rash occurring on the lower extremities, abdominal pain or renal involvement, and arthritis. However, any of the triad may be absent, which often leads to a confusion in diagnosing the condition. Although the cause is unknown, Henoch-Schönlein purpura (HSP) is often associated with infectious agents, such as group A streptococci and mycoplasma. It has also been associated with food reactions, exposure to cold, insect bites, and drug allergies. The treatment is supportive and needs close followup of renal status. This report describes a rare presentation of Henoch-Schönlein purpura with coronary vasculitis which leads to myocardial infarction at the age of 53. Henoch-Schönlein purpura was diagnosed on the basis of no infection, accelerated ESR (35 mm/h), normal platelet count, positive skin biopsy, proteinuria, and negative searches for rheumatoid factor (RF), antinuclear antibody (ANA), antineutrophil cytoplasmic antibodies (ANCA), and anti-dsDNA.

The prevalence and clinical profile of angiographic coronary ectasia.

Coronary artery ectasia, a variant of coronary atherosclerosis, is a relatively rare entity. Review of literature did not reveal an exclusive study on isolated ectasia. We decided to analyse the clinical presentation and angiographic prevalence of this subset. A retrospective study of patients who underwent coronary angiogram in our institute over the past six years was carried out and the epidemiological, clinical and angiographic characteristics of patients with isolated ectasia were analysed. Distribution of ectasia was with a modification of the Markis classification. Among 6938 angiograms analysed, 134 (2%) had isolated ectasia. Of the 118 symptomatic patients, 34 (25%) had a history of or presented with infarction, with correlation between the territory of infarction and the ectatic vessel in 32 patients. Of 62 patients with lipid abnormality, Hypertriglyceridemia in 42 (65%) was the most common. The left anterior descending artery was the most common vessel involved. Diffuse ectasia most commonly involved the right coronary artery. One patient had spontaneous coronary dissection. There is a relatively high prevalence of isolated coronary ectasia with predominant involvement of the right coronary vessel when diffuse and the left anterior descending artery when discrete. This entity is not innocuous and warrants a detailed study on the available management options.