Extensive involvement of the myocardium and the cardiac conduction system in a case of Wegener's granulomatosis

A 61-year-old female who had shown Raynaud's phenomenon and articular swell ing for 10 years, was admitted to hospital because of fever of unknown orig in (FUO) and dry cough. She was diagnosed by skin biopsy to have a collagen disease or overlap syndrome. Anemia developed rapidly and FUO persisted, b ut blood culture was negative. Although indomethacin and prednisolone were administered for the progression of clinical signs and symptoms, severe dys pnea developed, resulting in bradycardia, followed by recurrent episodes of ventricular tachycardia. In spite of extensive treatment for her arrhythmi a she died on the 9th hospital day. An autopsy revealed generalized Wegener 's granulomatosis with extensive cardiac involvement. Necrotizing angitis a nd severe granulomatous inflammatory foci affected characteristically the c ommon bundle of His and right bundle branch in addition to the ordinary myo cardium.