Anterior ST-Segment Elevation Myocardial Infarction With Coronary Thrombosis in a Young Man with Newly Diagnosed HIV Infection and Pneumocystis jirovecii Pneumonia.
Yasin Aktaş
✦ AI-curated · Sources linked
Case in brief
A 36-year-old man with newly diagnosed, severely immunosuppressive HIV infection and Pneumocystis jirovecii pneumonia developed an acute anterior ST-segment elevation myocardial infarction 25 days after starting antiretroviral therapy. Angiography showed a 90–99% thrombotic lesion at the left anterior descending artery ostium, with preserved TIMI 3 flow. Because he was clinically stable and procedural risks were considered, intervention was deferred while he received antithrombotic therapy. Repeat angiography after 72 hours showed marked thrombus regression without significant residual stenosis, and no coronary intervention was needed. Antiphospholipid antibody testing was negative; broader thrombophilia testing was not performed.
What made this case unusual
A severe ostial coronary thrombotic lesion in a young man with advanced newly diagnosed HIV and active opportunistic infection regressed markedly over 72 hours with medical treatment alone, despite no coronary intervention.
Diagnostic / clinical pearl
Acute coronary thrombosis should remain in the differential for young patients with severe HIV-related immunosuppression and active opportunistic infection; preserved flow and clinical stability may inform procedural decisions.
Why it matters
The coexistence of profound immunosuppression, infection, and coronary thrombosis suggests a possible multifactorial prothrombotic state, but a single case cannot establish causality.