Immunoglobulin G4-related coronary periarteritis in a patient presenting with myocardial ischemia

Recent studies suggest that the cardiovascular system might be a possible target immunoglobulin G4-related disease. Here we present a 66-year-old man who was admitted to hospital because of chest symptoms suggestive of acute coronary syndrome. Besides luminal of the coronary arteries, marked periarterial thickening around the coronary artery was observed computed tomography coronary angiography. Scrum immunoglobulin G4 levels of this patient elevated (564 mg/dL). The patient underwent coronary bypass surgery. After incision of pericardium, a glittery white-yellowish, elastic-hard periarterial mass surrounding the left artery could be seen. Histologic analysis of the biopsy specimen showed the formation of follicles and the presence of immunoglobulin G4 positive plasma cells; therefore, the diagnosis immunoglobulin G4 related coronary periarteritis accompanied by physiologically myocardial ischemia. (C) 2012 Elsevier Inc. All rights reserved.