A 25-year-old man with a history of erythromelalgia of the left hand in childhood.
No known cardiovascular risk factors or drug consumption, which in October 2006 had transient retro- or depressive pain associated with exertion.
The electrocardiogram showed no ischemia.
Two months later, the patient presented with pain of similar characteristics, lasting 3 h and consulted after 24 h of evolution.
The electrocardiogram showed ST elevation from V2 to V5, negative T wave from V2 to V6 and aVL and Q wave in V2 - V3.
Cardiac enzymes were elevated with troponin up to 35.54 ng/ml.
The echocardiogram showed marked hypokinesia, not thinned distal anteroseptal, anterior and apical.
Physical examination was normal, including blood pressure.
The lipid profile was normal as well as the blood count, including platelet count.
The corona-riography performed 48 h later showed a thrombotic lesion of 80% of the proximal third of the anterior descending artery, without finding atheromatous lesions.
IgM/ IgG serpent IgM: IgG/ IgM: IgG/ IgM: IgG/ IgM: IgG/ serpent, IgG/ IgM: IgG/ IgM: IgG/ IgM LPL 15, IgG/ IgM:
Anti-DNA and ENA profile were negative and complements were normal.
A primary APS was diagnosed and anticoagulation was initially indicated with heparin and subsequently with oral anticoagulant that was maintained permanently.
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Three months later, coronary angio-CT showed complete reperfusion of the involved vessel.
Two years later he was asymptomatic, being treated with atenolol, ramipryl, aspirin and hydroxychloroquine (Plaquinol®), in addition to permanent oral anticoagulation.
The echocardiogram showed mild anteroapical hypokinesia and low normal systolic function with an ejection fraction of 53% by Simpson.
