CASE REPORT article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1625491
This article is part of the Research TopicCase Reports in Coronary Artery Disease: 2025View all 13 articles
Case report -Coronary Plaque Rupture Following Glucocorticoid Tapering in a High-Risk CAD Patient with Immune Nephritis: Mechanistic Insights and Clinical Implications
Provisionally accepted
- Shenzhen Hospital, Peking University, Shenzhen, China
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Glucocorticoids (GCs) exhibit metabolic risks that might accelerate atherosclerosis. However, invivo effects of glucocorticoids on atherosclerotic plaques are still poorly understood. This case highlights the perilous interplay between chronic GC use and plaque vulnerability during dose reduction.A 51-year-old male with immune nephritis, chronic kidney disease (CKD), and poorly controlled hypertension presented with unstable angina. Coronary angiography revealed multivessel disease (70% stenosis in the proximal left anterior descending artery [LAD], 90% in the posterior descending artery). Initial management included angioplasty with drug coating balloon in posterior descending artery, dual antiplatelet therapy, statins, and prednisone (10 mg/day). Seven months later, after self-reducing GCs to 5 mg/day, he suffered an acute myocardial infarction due to LAD plaque rupture, confirmed by optical coherence tomography (OCT) showing fibrolipid-rich plaques, deep calcifications, and minimal lumen area (0.67 mm²). Emergency stenting stabilized the patient, with no recurrence at 3-month follow-up.The case underscores GCs' mechanistic duality. Chronic GCs suppress pro-inflammatory cytokines and macrophage activity, stabilizing plaques by reducing oxidized LDL uptake. However, abrupt tapering may trigger rebound vascular inflammation, destabilizing high-risk lesions. OCT imaging proved critical in identifying vulnerable plaque morphology, emphasizing its role in guiding urgent interventions.
Keywords: case report, Glucocorticoid tapering, Coronary plaque rupture, Optical Coherence Tomography, immune nephritis, Inflammation-driven atherosclerosis
Received: 09 May 2025; Accepted: 11 Aug 2025.
Copyright: © 2025 Weng, Piao, Lai, Chen, Sun and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tan Xu, Shenzhen Hospital, Peking University, Shenzhen, China
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