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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.

European Journal of Case Reports in Internal Medicine
|May 14, 2021
PubMed

Insights

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.

Keywords:
ST-elevation myocardial infarctionSpontaneous coronary artery dissectionblastomycosis

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