title: An anomalous case of acute coronary syndrome: the unexpected autoimmune duo.
abstract: : Acute coronary syndrome represents one of the most common causes of admittance to emergency rooms in Western countries. Despite being in the majority of cases the mirror of coronary atherosclerosis, more rare causes could be hidden beyond this presentation, whose identification is often crucial for patients' outcome. We hereby present the case of a 44-year-old woman, with a history of relapsing-remitting multiple sclerosis in treatment with natalizumab, who was admitted to our division for an acute coronary syndrome. At arrival, anaemia and severe thrombocytopenia were observed; thus, no antiplatelet agent was administered. Within a few hours, aphasia occurred. Clinical presentation and the identification of schistocytes at blood smear led to the suspicion of thrombotic thrombocytopenic purpura, which was then confirmed by laboratory analysis. Immediate high-dose steroids and plasma exchange allowed discharging of the patient within a few days without neurological or cardiac sequelae.
authors.affiliation: aDivision of Cardiology bDivision of Haematology, Ospedale Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Verdoia
authors.forename: Gabriele
authors.initials: G
authors.lastname: Dell'Era
authors.forename: Gabriella
authors.initials: G
authors.lastname: Di Giovine
authors.forename: Miriam
authors.initials: M
authors.lastname: Bortnik
authors.forename: Paola
authors.initials: P
authors.lastname: Zigrossi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Gaidano
authors.forename: Paolo
authors.initials: P
authors.lastname: Marino
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D000328:Adult; D015551:Autoimmunity; D002533:Cerebral Angiography / Q000379:methods; D000072226:Computed Tomography Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology; D000069442:Natalizumab / Q000008:administration & dosage; D010951:Plasma Exchange; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D013256:Steroids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000069442:Natalizumab; D013256:Steroids