Title : Coronary artery aneurysm and thrombosis associated myocardial infarction in a 24-year-old with multisystem inflammatory syndrome and human immunodeficiency virus
Abstract:
Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare complication of SARS-CoV-2 infection resulting in severe delayed systemic hyperinflammatory disease. The criteria for MIS-C is patient age < 21, fever with evidence of significant inflammation and multiple organ involvement following infection or exposure to SARS-CoV-2. The cardiovascular system is commonly involved with complications including ventricular dysfunction, arrhythmia, conduction abnormalities and coronary artery aneurysm (CAA). The inflammatory nature of Human Immunodeficiency Virus (HIV) can also result in unique and accelerated cardiovascular complications. Mechanisms such as coagulation abnormalities, vascular inflammation and endothelial dysfunction can result in unusual plaque morphology and vessel ectasia with an increased relative risk of myocardial infarction. We present the first case of coronary artery aneurysm with thrombus and myocardial infarction without atherosclerotic stenosis in the setting of MIS-C and HIV. This case represents a unique cause of acute coronary syndrome. Early identification and treatment of myocardial infarction in patients with MIS-C or HIV presenting to the emergency department is important as these patients are young and lack traditional characteristics of coronary artery disease.
