Disseminated Blastomycosis Presenting with Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of acute coronary syndrome (ACS) and myocardial infarction (MI) in individuals with few or no known atherosclerotic risk factors. While systemic autoimmune inflammatory disorders are associated with precipitating SCAD, the role of infection-induced systemic inflammation in SCAD is not well defined. We present the case of a 49-year-old Caucasian woman with ST-elevation myocardial infarction (STEMI) diagnosed as SCAD from a severe systemic inflammatory response related to disseminated blastomycosis. Punch biopsy of a skin lesion and synovial fluid culture confirmed Blastomyces dermatitidis. This case suggests the possibility of systemic infection-induced inflammation as a precipitating factor in SCAD pathogenesis similar to autoimmune inflammatory disorders. LEARNING POINTS: Recognize the role of systemic inflammation from severe infection as a possible cause of spontaneous coronary artery dissection (SCAD).Recognize that cardiac involvement is rare in blastomycosis.Coronary revascularization may be required in SCAD for haemodynamic instability, ischaemic chest pain progression, and myocardium at risk. © EFIM 2021.