Complete Heart Block due to Limited Wegener’s Granulomatosis: A Case Report

Abstract

Complete heart block is a rare manifestation of various cardiac involvements seen in Wegener’s granulomatosis. To our knowledge there have only been two previous cases of complete heart block reported in patients with limited form of Wegener’s granulomatosis in English literature. We describe a 62-year-old Iranian woman presenting with complete heart block who was candidate for pacemaker insertion. Limited Wegener’s granulomatosis was suspected because of bloody nasal discharge, fatigue, fever, arthralgia, dacrocystitis, and history of recurrent subglutic stenosis, but no renal involvement. The diagnosis was subsequently confirmed by presence of granuloma in nasal mucosal biopsy and also high level of serum anti-proteinase 3. Prednisolone and cyclophosphamide therapy was started and her electrocardiography returned to normal sinus rhythm. Awareness of unusual presentation of Wegener’s granulomatosis is important for proper diagnosis and management of the potentially fatal cardiac involvement of the disease. Complete heart block may be reversed by appropriate medical therapy of Wegener’s granulomatosis.