Left Atrial Myxoma Mimicking Polyarteritis Nodosa

• The authors have no financial conflicts of interest. which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Dear Editor: Vasculitis leads to a loss of function in effected tissues and organs. Although the Chapel Hill consensus has established criteria for the classification of vasculitis, 1 many disorders, such as infections, cholesterol embolism, fibromuscular dysplasia, and atrial myxoma, can present as vasculitis in terms of clinic, laboratory, or radio-graphical findings. 2-4 Here, we present 32-year-old female patient with left atrial myxoma mimicking polyarteritis nodosa. The patient referred to our clinic with fatigue, weakness, arthralgia, myalgia, and weight loss of 5 kg over the previous six months, during which time she had been taking metoprolol for hypertension. Physical examination revealed a temperature of 37.5°C, blood pressure of 160/100 mm Hg, and a pulse rate of 85 beats/min. No neurological and cardiopulmonary abnormalities, like murmurs, were noted. On clinical examination, she had ischemia on the second, third, and fourth digits of the right lower extremity. The patient's laboratory test results were as follows: white blood cell count, 8600/mm 3 test results were within normal ranges, and urine test was negative for proteinuria and hematuria. Serum elec-trophoresis revealed polyclonal gammopathy. Rheumatoid factor, anti-nuclear anti-body, anti-neutrophil cytoplasmic antibody, cryoglobulin, antiphospholipid an-tibodies, anti-hepatitis A virus IgM, anti-hepatitis C virus, anti-human immunode-ficiency virus, cytomegalovirus IgM, and Epstein-Barr virus viral capside antigen were negative. The patient was positive for hepatitis B virus (HBV) surface antigen, as well as HBeAg negative and anti-HBe positive, with HBV-DNA titres of 920 IU/ mL. Abdominal ultrasonography revealed grade 1 hepatic steatosis. Based on clinical and laboratory findings, the case was diagnosed as polyarteritis nodosa, and treatment with corticosteroid (1 mg/kg/day) was initiated. We planned to monitor HBV-DNA, ALT, liver function tests, and started lamivudine due to immunosup-pressive treatment. Due to complaints of fatigue, weakness, and hypertension on follow-up, an echocardiography was performed, at which time a left atrial lesion of 3.2×2 cm in size was discovered. Pulmonary arterial pressure was 54 mm Hg. Atri-al myxoma was diagnosed with histopathological confirmation after cardiac surgical removal of the lesion. The steroid dose was reduced gradually, and then stopped. Also, magnetic resonance angiography was performed for vasculitis. The results were normal without aneurysms or occlusions of the visceral arteries. The patient