Myocardial infarction in a young man with ulcerative colitis and polycythemia vera: а case report

Introduction. Myocardial infarction (MI) developing before the age of 45 is not casuistic, but is often associated with conventional risk factors, chronic non-cardiac diseases, being the first reason for seeking medical help. Patients with inflammatory bowel diseases are at increased risk of cardiovascular diseases, gastrointestinal cancer, and extraintestinal cancer, including myeloproliferative neoplasms. A common genetic predisposition to myeloproliferative and inflammatory diseases, including inflammatory bowel disease, is described. In contrast, myeloproliferative diseases are often associated with abdominal pain syndrome, thrombosis of various locations.

Brief description. We describe a case of a 40-year-old man with MI at the start of corticosteroid and mesalazine therapy for newly diagnosed ulcerative colitis. Percutaneous coronary angioplasty with stenting of the anterior descending artery was performed. The early postoperative period was complicated by acute stent thrombosis, which required repeated stenting and intra-aortic balloon counterpulsation. Despite the 1-year dual antiplatelet therapy (DAPT) after discharge from the hospital, intestinal bleeding did not relapse against the background of treatment of ulcerative colitis. Immunosuppressive therapy included azathioprin. Glucocorticosteroid therapy was discontinued due to high risk of thrombosis. Anti-inflammatory therapy was carried out with mesalazine. During hospitalization, thrombocytosis was diagnosed for the first time. Hematologist diagnosed JAK+ polycythemia vera, and cytoreductive therapy with hydroxyurea was prescribed.

Discussion. MI was obviously associated with thrombosis against the background of chronic myeloproliferative disease and inflammatory bowel disease. Management of such patients is difficult due to the high risk of thrombotic and hemorrhagic events. DAPT was not associated with bleeding. Myeloproliferative diseases, inflammatory bowel diseases should be taken into account in patients with early onset of coronary artery disease for their timely diagnosis and development of a secondary prevention plan.

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