JACC. Case reports · 2026
Transient Coronary Thrombosis Mimicking Myopericarditis Revealing JAK2-Positive Essential Thrombocythemia.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Kosum Paisit, Pipatputthapong Akenarong, Jittham Pongpun, Songsirisuk Nattakorn, Wong Peerapon, Deoisares Rawisut, Phumviwattanasirikul Koravich, Banlue Worathon, Theerasuwipakorn Nonthikorn, Pravarnpat Chalinee
Аннотация
BACKGROUND: Acute coronary thrombosis without atherosclerosis may mimic myopericarditis, particularly in young patients.
CASE SUMMARY: A 20-year-old woman presented with pleuritic chest pain following a viral illness. Serial electrocardiography showed dynamic ST-segment elevation in leads V3 to V6, and high-sensitivity troponin T increased from 18.6 to 1,151 ng/L. Echocardiography demonstrated regional wall motion abnormalities in the left anterior descending territory. Coronary angiography revealed a proximal left anterior descending intraluminal thrombus causing severe narrowing without underlying atherosclerosis. Conservative management with anticoagulation and dual antiplatelet therapy was initiated. Repeat angiography after 3 days showed complete thrombus resolution with no residual stenosis. Further evaluation revealed marked thrombocytosis and a JAK2 V617F mutation, confirming essential thrombocythemia.
DISCUSSION: This case highlights a mechanism-based approach to myopericarditis-like presentations. JAK2-positive essential thrombocythemia represents a plausible prothrombotic contributor after the exclusion of common causes of coronary artery disease in very young patients.
TAKE-HOME MESSAGE: Dynamic regional electrocardiogram changes, rapid troponin elevation, and regional wall motion abnormalities should prompt coronary evaluation despite pleuritic symptoms.
CASE SUMMARY: A 20-year-old woman presented with pleuritic chest pain following a viral illness. Serial electrocardiography showed dynamic ST-segment elevation in leads V3 to V6, and high-sensitivity troponin T increased from 18.6 to 1,151 ng/L. Echocardiography demonstrated regional wall motion abnormalities in the left anterior descending territory. Coronary angiography revealed a proximal left anterior descending intraluminal thrombus causing severe narrowing without underlying atherosclerosis. Conservative management with anticoagulation and dual antiplatelet therapy was initiated. Repeat angiography after 3 days showed complete thrombus resolution with no residual stenosis. Further evaluation revealed marked thrombocytosis and a JAK2 V617F mutation, confirming essential thrombocythemia.
DISCUSSION: This case highlights a mechanism-based approach to myopericarditis-like presentations. JAK2-positive essential thrombocythemia represents a plausible prothrombotic contributor after the exclusion of common causes of coronary artery disease in very young patients.
TAKE-HOME MESSAGE: Dynamic regional electrocardiogram changes, rapid troponin elevation, and regional wall motion abnormalities should prompt coronary evaluation despite pleuritic symptoms.