Acute myocardial infarction in a 9-year-old boy due to multisystem inflammatory disease

ABSTRACT

Background and Aim: Myocardial infarction after coronavirus dis-ease 2019(COVID-19) is a quite uncommon clinical disease in children. We present a case about a 9-year-old boy with total occlusion of the right main coronary artery(RMCA) attending to the hospital with chest pain. It was related pediatric multisystem inflammatory disease (MIS-C). Method(s) It is a case presentation. Result(s) Case Presentation The patient had no previous cardiac or family history. Electrocardiography(ECG) showed a definite elevation on the extremity derivatives(DI, DII, DIII, and aVF), and marked ST depression on the chest derivatives (V1 to V6) and aVR, aVL, all representing lateral inferior ischemia. Transthoracic echocardi-ography revealed left ventricular systolic dysfunction, and global wall hypokinesia. Existence of fever and two-body system involvement (cardiac, gastrointestinal), CRP rise, and prior SARS-CoV-2 exposure in a month, MIS-C was a foremost diag-nosis. The total antibody for SARS-CoV-2 was positive. Lipid profiles(LDL, HDL, VLDL, triglyceride), lipid electrophoresis, routine coagulation, and thrombophilia tests were evaluated for differential diagnosis and all were normal. Because of the possible MI, it was planned to visualize coronary arteries by angiography. Total occlusion of the right main coronary artery(RMCA) with a large thrombus was detected without any dilatation of the coro-nary arteries in the coronary angiography. Two coronary stents were implanted into the distal and proximal part of the RMCA. After the procedure, clopidogrel was added to acetylsalicylic acid for platelet inhibition. During the follow-up, LVEF rose to 55% and there was a little hypokinesia on the left inferior wall of ventricles. Conclusion(s). It should be kept in mind that acute coronary throm-bosis could be an important complication of COVID-19 exposure or MIS-C. A coronary stent implantation is a good treatment option even in small children.