The Wolf's bite: acute myocardial infarction in a 19-year-old man with systemic lupus erythematosus and antiphospholipid syndrome

Abstract

Acute myocardial infarction in the young adult population represents a diagnostic and therapeutic challenge. Different causes have been postulated, such as atheromatous coronary artery disease, non-atheromatous coronary artery disease, hypercoagulable states, and secondary to substance abuse. We present the case of an adolescent who comes to the emergency room with chest pain. The initial electrocardiogram showed a repolarization disorder, high-sensitivity troponin T was positive, the transthoracic echocardiogram did not show contractility disorders, however, the cardiac magnetic resonance showed subendocardial infarction of the apical cap. Cardiac catheterization revealed total occlusion of the proximal anterior descending artery and severe occlusion of the first diagonal. Immune laboratories with ANAS 1/2560, negative anti-dsDNA, decreased complement, triple positive antiphospholipid syndrome profile. During clinical observation, he developed post-infarction myopericarditis, requiring immunosuppressive management and anticoagulation. Surgical myocardial revascularization was performed as a coronary reperfusion strategy, with adequate postoperative evolution. This case highlights the importance of rheumatic diseases in the genesis and development of accelerated atherosclerotic disease and its manifestation as acute coronary syndrome in young people.