A team from Rochester Regional Health in New York has reported the rare case of a patient with paroxysmal nocturnal hemoglobinuria (PNH) who became infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—the virus causing coronavirus disease 2019 (COVID-19)—and experienced cardiac arrest secondary to inferior ST segment elevation myocardial infarction.
At clinical admission, the patient, a 63-year-old man with a previous medical history of PNH who was not on medical therapy, complained of acute, crushing, retrosternal chest pain with radiation to the neck and left arm. He also mentioned having fever, chills, fatigue, runny nose, jaundice, and dark-colored urine over the few days prior.
“Early and thorough cardiological evaluation for acute coronary syndrome in patients with PNH presenting with chest pain is essential and life-saving. Also, early initiation of monoclonal antibody C5 inhibitors, such as eculizumab and ravulizumab, can decrease the risk of intravascular hemolysis and thrombosis,” Mohamed et al wrote in Cureus.
Although the patient was hemodynamically stable and showed no evidence of anomalies on cardiac examination, he eventually suffered from cardiac arrest secondary to ventricular fibrillation and received cardiopulmonary resuscitation.
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Subsequent examination revealed inferior wall ST segment elevation myocardial infarction. His hemoglobin level was 6.4 g/dL, and he had elevated levels of cardiac markers, serum lactate dehydrogenase, and indirect bilirubin. Moreover, he tested positive for COVID-19.
The patient received packed red blood cell transfusions and underwent a coronary angiogram, showing complete proximal occlusion of the right coronary artery.
The clinical team successfully managed the situation with percutaneous transluminal coronary angioplasty and the placement of 2 drug-eluting stents. After the procedure, the patient initiated dual antiplatelet therapy.
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The results of the patient’s peripheral blood immunophenotyping and flow cytometry analysis were consistent with PNH. He initiated ravulizumab to prevent further hemolysis and thrombosis.
At the 1-month follow-up consultation, the patient was free of symptoms and experienced no further episodes of chest pain or hemolysis.
Reference
Mohamed MS, Mahmoud A, Hashem A, Abdelhay A, Balmer-Swain M. Cardiac arrest secondary to inferior ST-segment-elevation myocardial infarction in patient with paroxysmal nocturnal hemoglobinuria and COVID-19 infection. Cureus. Published online March 24, 2023. doi:10.7759/cureus.36632
