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Disseminated Blastomycosis Presenting with Spontaneous Coronary Artery Dissection
Rahul Sehgal1, D Fearghas O'Cochlain2, Andrew R Virata3
1Department of Rheumatology, Mayo Clinic Alix School of Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA.
Summary
Severe infection-induced systemic inflammation may cause spontaneous coronary artery dissection (SCAD), a condition often seen in acute coronary syndrome. This case highlights blastomycosis as a potential trigger for SCAD.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndrome (ACS) and myocardial infarction (MI).
- The link between infection-induced systemic inflammation and SCAD is not well-established, unlike autoimmune disorders.
- SCAD typically affects individuals without traditional atherosclerotic risk factors.
Purpose of the Study:
- To present a case of SCAD precipitated by systemic inflammation from disseminated blastomycosis.
- To explore the potential role of severe infections as a trigger for SCAD.
Main Methods:
- Case report of a 49-year-old woman with ST-elevation myocardial infarction (STEMI).
- Diagnosis of SCAD was made based on clinical presentation and imaging.
- Confirmation of disseminated blastomycosis via skin biopsy and synovial fluid culture for *Blastomyces dermatitidis*.
Main Results:
- The patient presented with STEMI attributed to SCAD.
- The SCAD was associated with a severe systemic inflammatory response due to disseminated blastomycosis.
- Identification of *Blastomyces dermatitidis* confirmed the infectious etiology.
Conclusions:
- Systemic inflammation from severe infections, such as blastomycosis, should be considered a potential cause of SCAD.
- Cardiac involvement is a rare but serious complication of blastomycosis.
- Coronary revascularization may be necessary for SCAD patients experiencing hemodynamic instability or worsening ischemia.
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