MPO and acute coronary syndrome: During a four-month follow-up after discharge, no recurrent angina or ischemic events were reported.<h4>Conclusion</h4>In a p-ANCA/MPO-positive AAV patient with sustained normolipidemia, we observed rapidly progressive LM/LAD disease occurring in parallel with aortic involvement, which was consistent with an inflammation-driven coronary phenotype that precipitated acute coronary syndrome.