CT Coronary Angiogram in Diagnosing IgG4 of Coronary Arteries Presenting as Acute Coronary Syndrome: A Case Report with Literature Review

Immunoglobulin G4-related disease (IgG4 RD), first described in 2001, as a case of autoimmune pancreatitis, is a multisystemic condition, involving the salivary glands, bile ducts, pancreas, retroperitoneal organs, and mesentery and is associated with raised level of serum IgG4. Reports of coronary involvement by IgG4 RD are scarce and we could find only 16 case reports in the literature. Here, we present a case of a 61-year-old lady, with no known comorbidities, who presented with rapid progression of coronary artery stenosis. Initially, she presented with mild stenosis of left anterior descending which rapidly progressed to significant triple vessel disease in 3 months. Serological workup for antibodies was negative, except for raised serum IgG4 antibodies. She was managed effectively with steroids.