Coronary artery aneurysm and thrombosis associated myocardial infarction in a 24-year-old with multisystem inflammatory syndrome and human immunodeficiency virus: a case report

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) and Human Immunodeficiency Virus (HIV) are both systemic inflammatory diseases that rarely result in coronary artery aneurysms (CAA). Interventional treatment and management of CAA pose a challenge to clinicians with no current guideline recommendations. We present the first case of CAA with thrombus and myocardial infarction in the setting of both MIS-C and HIV. Case summary: 24-year-old male with a background of MIS-C and HIV presented with chest pain, anterior ST-segment elevation and troponin I > 50 000 ng/L, complicated by three cardiac arrests with pulseless ventricular tachycardia requiring direct cardioversion. Angiogram showed left anterior descending (LAD) CAA measuring 8 × 9 mm with an occlusive thrombus in the proximal LAD. Initial angioplasty and thrombectomy attempts were unsuccessful. Intracoronary thrombolysis was administered, followed by further balloon inflations and thrombus aspiration with restoration of TIMI3 flow. Discussion: This case is significant as it highlights a novel presentation of myocardial infarction in a young adult. We propose a high index of suspicion of thrombotic events in all patients with known MIS-C or HIV to ensure timely identification and management. We also highlight the complexity in decision-making in interventional and long-term management of CAA with large intracoronary thrombosis and the need for further research into optimal approaches.