Recurrent myocardial infarction associated with vasculo-Behçet's disease: a case report

Abstract

A 39-year-old Japanese man presented with chest oppression in February 2017. Electrocardiogram showed ST-elevation myocardial infarction (MI), and cardiac catheterisation revealed thrombotic occlusion of the right coronary artery (RCA), which was treated with thrombectomy, and he received warfarin. Three days after discharge, he complained of chest oppression again, and re-cardiac catheterisation showed thrombi occlusion of the circumflex artery (LCX) and 90% stenosis with thrombosis in the proximal site of the anterior descending artery (LAD) and RCA. Drug eluting stent was implanted in the LAD and RCA; aspirin and prasugrel hydrochloride were added to warfarin. Before discharge, coronary computed tomography angiography (CTA) found new thrombi in the RCA, LAD, and LCX, and he was referred to our hospital on suspicion of Behçet’s disease (BD). Past medical history was notable for recurrent aphthous stomatitis, a pudendal ulcer, and Crohn’s disease, for which he had been taking infliximab (5 mg/kg) every 8 weeks until December 2016. Notably, his C-reactive protein (CRP) level increased before and after each MI, suggesting that the thrombi were caused by inflammation. Consequently, we concluded that his abnormalities were manifestations of vasculo-BD. After 3 days of hospitalisation, treatment with prednisolone and colchicine was started. His CRP and D-dimer levels decreased, and coronary CTA after 8 days showed disappearance of the thrombi. We tapered the prednisolone dose, and cardiovascular events have not been observed for 7 months after the treatment initiation. In summary, we report a rare case of MI associated with vasculo-BD and review the relevant literature.

Keywords:

• Myocardial infarction
• vasculo-Behçet’s disease
• infliximab
• Crohn’s disease
• C-reactive protein

Acknowledgments

We would like to thank Dr. Masanori Asakura of Hyogo College of Medicine, Department of Internal Medicine, Cardiovascular division, for his useful discussion.

Patient consent

A written informed consent for publication of this case report was obtained from the patient.

Ethical Approval

Not Applicable.

Disclosure statement

Kiyoshi Matsui has received consulting fees, speaking fees, and/or honoraria from Bristol-Myers Squibb, Astellas, Chugai, and has received research grants from Astellas, Chugai and Asahikasesei Pharma. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; and in the decision to publish the results.