[Hematologic chest pain].
METHODS
We report the case of a 59-year-old male who was admitted to hospital with acute chest pain. Coronary heart disease was known from the medical history. The patient reported recurrent ostealgia and susceptibility for infection during the last months before admission.


METHODS
A 75% stenosis of the circumflex branch was treated with a drug eluting stent. Platelet aggregation was inhibited with acetylsalicylic acid and clopidogrel. Due to persisting ostealgia and inflammatory state, spondylodiscitis was excluded in MRI. However, platelets remained low after successful treatment of the infection.


METHODS
Bone marrow biopsy revealed an acute lymphoblastic leukemia with positive detection of the Philadelphia chromosome. After chemotherapy and allogenic hematopoietic cell transplantation the patient remains in remission of his acute lymphoblastic leukemia.


CONCLUSIONS
Especially in patients with documented history of coronary heart disease, the differential diagnosis of chest pain can be challenging. In this case, the chest pain was based on a subacute coronary ischemia as well as on proliferation of the acute lymphoblastic leukemia. The management of dual oral anticoagulation was performed with higher transfusion limits for thrombocytes and continuous application of thrombocyte aggregation inhibitors.
Sebastian Peter
SP
Haen
Rebekka
R
Mannal
Martin
M
Steeg
Peter
P
Seizer
Michaela
M
Rockenstiehl
Susanne
S
Mackensen-Haen
Marius
M
Horger
Lothar
L
Kanz
Wichard
W
Vogel
D064591:Allografts; D001856:Bone Marrow Examination; D017024:Chemotherapy, Adjuvant; D002637:Chest Pain / Q000209:etiology*; D003327:Coronary Disease / Q000150:complications*; D003937:Diagnosis, Differential; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy
D010975:Platelet Aggregation Inhibitors