Cardiovascular Journal of Africa: Vol 31 No 1 (January/February 2020)

57 / 62

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 1, January/February 2020 AFRICA e1
Case Report
A giant aneurysm of the left anterior descending
coronary artery in the setting of Behcet’s disease
Mejdi Ben Messaoud, Nidhal Bouchahda, Ayoub Belfekih, Fadwa Omri, Mezri Maatouk, Walid Mnari,
Habib Gamra
Abstract
Behcet’s disease is a chronic inflammatory syndrome that can
affect arteries and veins of all sizes and is an unusual cause
of myocardial infarction. We report a case of a 42-year-old
male with no cardiovascular risk factors who was referred
to our department for a spontaneously resolving anterior
ST-elevation myocardial infarction. Clinical and biological
investigations revealed a high probability for Behcet’s disease.
The coronary angiogram showed severe left main artery steno-
sis with a huge coronary aneurysm of the proximal left anteri-
or descending coronary artery, which was treated by aneurysm
resection and coronary artery bypass grafting. Inflammatory
arteritis should be considered in young patients with low
cardiovascular risk presenting with acute coronary syndrome.
Keywords: Behcet syndrome, coronary aneurysm, acute coronary
syndrome
Submitted 28/3/19, accepted 8/5/19
Cardiovasc J Afr 2020; 31: e1–e3
DOI: 10.5830/CVJA-2019-031
Acute coronary syndrome in young patients with low
cardiovascular risk is rare but it can reveal non-atherosclerotic
aetiologies such as systemic inflammatory syndromes. In this
article we report on the case of a giant coronary artery aneurysm
in a young man with no cardiovascular risk factors, who was
admitted for acute coronary syndrome.
Case report
A 42-year-old male with no cardiovascular risk factors was
admitted in our department for a spontaneously resolving
anterior ST-elevation myocardial infarction. The initial physical
examination revealed a fever of 38.5°C with mouth and genital
aphthous ulcers.
Laboratory tests showed a marked elevation of white blood
cells at 17 800 cells/μl (normal range: 4 000–11 000 cells/μl),
C-reactive protein at 252 mg/l (normal value < 6 mg/l) and
erythrocyte sedimentation rate of 95 mm/h (normal value <
15 mm/h) with positive pathergy test and negative antinuclear
antibodies. Based on these findings, Behcet’s disease was strongly
suspected, and other inflammatory systemic diseases such as
systemic lupus erythematous were much less likely.
Echocardiography showed a preserved left ventricular ejection
fraction and a vascular mass between the aorta and pulmonary
trunk with an accelerated continuous-wave Doppler flow inside
the mass (Fig. 1). The coronary angiogram showed severe left
main artery stenosis, a huge aneurysm (43 × 33 mm) of the
proximal left anterior descending artery causing slow flow,
and another smaller (10 × 8 mm) aneurysm of the distal right
coronary artery (Fig. 2). A coronary computed tomography scan
confirmed the above findings and showed a partial thrombosis
of the left anterior descending artery aneurysm that was
compressing the pulmonary trunk (Fig. 3).
The patient was given corticosteroids and immunosuppressive
therapy (cyclophosphamid), with a favourable outcome. One
month later, he underwent successful cardiac surgery consisting
of a resection of the huge aneurysm and bypass of the left
anterior descending and circumflex arteries.
Follow up at six months with a clinical and echocardiographic
evaluation was unremarkable. Because the patient was
asymptomatic, no other tests for myocardial ischaemia, such
as stress test were performed. Inflammatory markers including
C-reactive protein were negative.
Discussion
Behcet’s disease is a multisystem vasculitis that can involve
vessels of all sizes and is characterised by recurrent oral and
genital ulcers, with variable manifestations affecting the skin,
eyes, central nervous and musculoskeletal systems.1 Venous and
arterial involvement and aneurysm formation of the vascular
tree may be seen. First described by Schiff et al.2 as a myocardial
infarction, coronary involvement in Behcet’s disease is very rare
(0.5%).3
Cardiology Department, Cardiothrombosis Research
Laboratory, University of Monastir and Fattouma
Bourguiba University Hospital, Monastir, Tunisia
Mejdi Ben Messaoud, MD
Nidhal Bouchahda, MD
Ayoub Belfekih, MD
Fadwa Omri, MD
Habib Gamra, MD,
Radiology Department, Interventional Radiology Research
Laboratory, University of Monastir and Fattouma
Bourguiba University Hospital, Monastir, Tunisia
Mezri Maatouk, MD
Walid Mnari,MD