A case study of Isolated Coronary Vasculitis Leading to Myocardial Infarction in an Adolescent

This article discusses a case of a 14-year-old girl who experienced an acute myocardial infarction (MI) caused by vasculitis affecting her coronary arteries. She initially presented with dizziness, a low-volume pulse, and normal blood pressure. An ECG indicated ST segment elevation, and elevated troponin T levels were noted. Tests ruled out a procoagulant state, revealing high anticardiolipin antibodies, indicative of primary antiphospholipid antibody syndrome. Further investigations showed a 90% blockage in the left main coronary artery, leading to coronary artery bypass grafting (CABG) using the left internal mammary artery.

Three months later, her anticardiolipin antibodies were negative, although they can be transiently elevated during infections. After eight months, she returned with menorrhagia, anemia, and shoulder pain, and coronary angiography revealed 80% obstruction. Six months later, she presented with abdominal pain and elevated inflammatory markers, while a perfusion study indicated hibernating myocardium. The patient's left ventricular (LV) function improved with immunosuppressive therapy, eliminating the need for stenting.

A fat biopsy indicated medium vessel vasculitis. While coronary vasculitis is known to occur in various conditions, isolated coronary involvement is rare. Childhood MI can stem from various causes, including coronary anomalies and vasculitis. This case highlights the importance of monitoring disease activity through clinical assessments and imaging in pediatric patients presenting with signs of vasculitis.

Source: Arun A, Biswal N, Anantharaj, A. Acute Myocardial Infarction in an Adolescent. Indian J Pediatr (2025). https://doi.org/10.1007/s12098-025-05452-7

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