Hypertensive Crisis and Myocardial Infarction With Non-obstructive Coronary Arteries in a Leprosy Patient With Erythema Nodosum Leprosum: The Role of Corticosteroids

TL;DR

A leprosy patient with a severe skin reaction experienced a heart attack-like event without blocked arteries, highlighting the possible role of corticosteroid treatment.

Contribution

This case highlights the potential link between ENL, corticosteroid use, and MINOCA in leprosy patients.

Findings

The patient experienced a hypertensive crisis and NSTEMI with non-obstructive coronary arteries.

ECG and cardiac biomarkers indicated a myocardial infarction despite no significant artery blockage.

The case suggests a possible association between ENL and cardiovascular complications in leprosy patients.

Abstract

A hypertensive crisis is a severe condition characterized by a sudden, critical rise in blood pressure, which can lead to organ damage. Myocardial infarction occurring in the absence of significant coronary artery stenosis is referred to as myocardial infarction with non-obstructive coronary arteries (MINOCA). Patients with leprosy may develop erythema nodosum leprosum (ENL), a serious inflammatory condition that can impair cardiovascular health and is frequently treated with corticosteroids. In this case, we describe a 52-year-old male patient, known to have hypertension, who complained of breathlessness, facial edema, and chest pain. Additional testing indicated hypertension, elevated cardiac biomarkers, and an ECG that showed characteristics of a non-ST segment elevation myocardial infarction (NSTEMI). When coronary angiography was performed, non-obstructive epicardial coronary arteries were discovered.

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