Myocardial Infarction With Nonobstructive Coronary Arteries in New-onset Inflammatory Bowel Disease.

Abstract

Inflammatory bowel disease (IBD) is a systemic pro-inflamma­tory condition with rare cardiovascular extraintestinal manifestations. Increasing evidence links gut inflammation and cardiovascular pathology, with myopericarditis encompassing approximately 70% of cases.1–3 Myocardial infarction with nonobstructive coronary arteries (MINOCA) has not been described in this population.4 A 36-year-old man with a history of gastroesophageal reflux disease and hypertension presented with a 10-day history of fever, hematochezia, and abdominal pain. Negative history included no travel, suspect foods, or drug use. Family history was negative for IBD or cardiac disease. Exam was unremarkable except for mild abdominal tenderness in bilateral lower quadrants. Labs revealed elevated white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. Admission troponin and electrocardiogram (ECG) were normal. Computed tomography (CT) abdomen and pelvis revealed diffuse bowel wall thickening and associated mesenteric inflammation of the entire colon. A stool infectious panel was negative. Sigmoidoscopy demonstrated diffuse continuous ulceration, friability, and granularity up to the splenic flexure (Figure 1A). Colon biopsies demonstrated diffuse, markedly active colitis. Although pathology had no evidence of chronicity, given a negative workup for infection or ischemia, no offending medications, no response to antibiotics, a characteristic endoscopic appearance, and a worsening clinical course that ultimately responded only to steroids, it was determined to be a diagnosis of early and new-onset ulcerative colitis.