Polyvascular thromboangiitis obliterans, systemic vasculitis overlap, anticytoplasmic antibodies and immune checkpoint inhibitor myocarditis: a systematic review
DOI:
https://doi.org/10.70577/sz5nm361Keywords:
thromboangiitis obliterans, Buerger's disease, ANCA-associated vasculitis, antineutrophil cytoplasmic antibodies, immune checkpoint inhibitors, myocarditis, polyvascularAbstract
Introduction: Thromboangiitis obliterans (TAO) is a non-atherosclerotic inflammatory vasculopathy affecting small and medium-sized vessels, typically in young male smokers, with a significant immune component evidenced by the presence of antineutrophil cytoplasmic antibodies (ANCA) in up to 55-73% of patients (Guo et al., 2013; Halbritter et al., 1998). Overlap with ANCA-associated vasculitis (AAV) is rare but documented (ACP Clinical Cases, 2024). Immune checkpoint inhibitors (ICIs) can trigger fulminant myocarditis, with <1% incidence but high mortality (Vyas et al., 2026). Objective: To synthesize the available evidence on polyvascular TAO, its overlap with AAV, the presence of ANCA, and ICI-induced myocarditis. Methodology: Systematic review following PRISMA 2020 guidelines (Page et al., 2021). A systematic search was conducted in PubMed and other sources for studies published between 1986 and 2026 on TAO, AAV, ANCA and ICI-induced myocarditis. Results: Eight relevant studies were identified. TAO can present with polyvascular involvement, including coronary involvement in 14.3% of cases (Kelemen et al., 2016). AAV-TAO overlap has been documented with positive ANCA and pauci-immune glomerulonephritis (ACP Clinical Cases, 2024). ANCA are present in 55-73% of TAO patients, correlating with disease severity (Guo et al., 2013; Halbritter et al., 1998). ICI-induced myocarditis can present fulminantly, with cardiac biomarker elevation and corticosteroid response (Vyas et al., 2026). Conclusion: Polyvascular TAO represents a destructive paradigm combining thrombotic vascular inflammation, systemic autoimmunity, and immune-mediated myocardial vulnerability, requiring a multidisciplinary diagnostic and therapeutic approach.
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Copyright (c) 2026 Eileen Del Carmen Maurad Farfán, Diana Elizabeth Caicedo Oleas, Sergio Antonio Villavicencio Zambrano, Byron Fernando Quituisaca Vizhñay, Katty Carola Salinas Flores (Autor/a)
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