Embolic myocardial infarction secondary to marantic endocarditis in a patient with ulcerative colitis: case report

Background Nonbacterial thrombotic endocarditis (NBTE) is an uncommon and often underdiagnosed condition characterized by a state of hypercoagulability. We present a case of a patient with ulcerative colitis who experienced a non-ST-segment elevation myocardial infarction as a rare complication of NBTE.Case summary We report a case of a 16-year-old male with a history of ulcerative colitis who presented to the emergency department with chest pain at rest. He was admitted to the cardiology ward with an initial suspected diagnosis of acute myocarditis. Transthoracic echocardiography revealed inferior septobasal hypokinesia and a mobile pedunculated mass attached to the aortic valve, although the valve's function was not compromised. Given the suspicion of an acute coronary syndrome of embolic origin, cardiac magnetic resonance imaging (MRI) with intravenous contrast was performed. The MRI revealed an evolved infarct in the territory of the right coronary artery. Biopsy of the material removed during surgery revealed findings consistent with thrombotic material.Case summary We report a case of a 16-year-old male with a history of ulcerative colitis who presented to the emergency department with chest pain at rest. He was admitted to the cardiology ward with an initial suspected diagnosis of acute myocarditis. Transthoracic echocardiography revealed inferior septobasal hypokinesia and a mobile pedunculated mass attached to the aortic valve, although the valve's function was not compromised. Given the suspicion of an acute coronary syndrome of embolic origin, cardiac magnetic resonance imaging (MRI) with intravenous contrast was performed. The MRI revealed an evolved infarct in the territory of the right coronary artery. Biopsy of the material removed during surgery revealed findings consistent with thrombotic material.Discussion We present a case of acute coronary syndrome as an unusual manifestation of NBTE in a patient with ulcerative colitis. Although we have not identified any reported cases in the literature involving ulcerative colitis, it is crucial to consider NBTE in patients with underlying conditions that predispose them to a procoagulant state. Furthermore, it is necessary to define criteria or guidelines for its diagnosis or treatment.