title: Acute Spontaneous Coronary Artery Thrombosis as Initial Presentation of HIV Infection in a Young Man.
abstract: Introduction. The presentation of acute coronary syndrome (ACS) in young HIV patients may be atypical with different pathophysiological and clinical features. Acute coronary thrombosis, as a presentation of acute coronary syndrome in young patients with HIV, raises diagnostic and treatment challenges. Case Presentation. We describe a case of a 33-year-old African man, without traditional atherosclerotic risk factors, who presented with chest pain of acute onset. Emergent coronary angiography revealed extensive thrombus in the left anterior descending coronary artery with no evidence of atherosclerosis in this or other coronary vessels. Plaque and/or thrombus prolapse through the stent was noted following percutaneous coronary intervention (PCI). Resolution of chest pain and improvement in ST-segment elevation was noted after the procedure. A diagnosis of HIV infection was made during the workup for HIV infection. Conclusion. In young patients without traditional risk factors, HIV infection is a possible etiological factor for spontaneous coronary artery thrombosis. Percutaneous coronary intervention in patients with this presentation may be compounded with atherothrombotic complications. The likely pathophysiological pathway is superficial endothelial cell denudation as a result of chronic inflammation and immune activation.
authors.affiliation: Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda ; Uganda Heart Institute, Ward 1C, Mulago Hospital Complex, P.O. Box 7051, Kampala, Uganda.
authors.forename: James
authors.initials: J
authors.lastname: Kayima
authors.affiliation: Uganda Heart Institute, Ward 1C, Mulago Hospital Complex, P.O. Box 7051, Kampala, Uganda.
authors.forename: Wilson
authors.initials: W
authors.lastname: Nyakoojo
authors.affiliation: Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda ; Infectious Disease Institute, Makerere University, P.O. Box 22418, Kampala, Uganda.
authors.forename: Damalie
authors.initials: D
authors.lastname: Nakanjako
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Costa
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Longenecker
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Simon
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