Uncommon Triple Vessel Spontaneous Coronary Artery Dissection in the Setting of Polyarteritis Nodosa: A Case Report

Abstract Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndromes (ACS) not related to atherosclerosis. It involves the sudden tearing of the coronary artery wall, separating the inner intimal lining from the outer vessel wall, typically affecting a single coronary vessel. In 20% of cases, the cause of SCAD is unknown. The other cases often occur in pregnant or postpartum women, or in individuals with conditions like connective tissue disorders or vasculitis. Here, we describe a case of a 69-year-old female presenting with non-ST-segment elevation myocardial infarction (NSTEMI). Coronary angiography revealed an unusual triple-vessel spontaneous coronary artery dissection (SCAD) affecting peripheral segments, with further investigations suggesting Polyarteritis nodosa (PAN). While triple-vessel SCAD and PAN are individually rare, their coexistence is exceptionally uncommon and presents diagnostic and therapeutic challenges. Clinicians should be alert to vasculitic causes in SCAD patients, especially with atypical clinical features.