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31 August 2022: Articles

Posterior Myocardial Infarction in a 45-Year-Old Javanese Woman with a 1-Month History of COVID-19-Related Guillain-Barré Syndrome: A Challenging Emergency Diagnosis

Challenging differential diagnosis

Ivan Satria Pratama B , Yudi Her Oktaviono A , Terrence Timothy Evan Lusida A*

DOI: 10.12659/AJCR.937105

Am J Case Rep 2022; 23:e937105

Table 1. Comparison of this case with other case reports describing acute coronary syndrome in GBS patients.

AuthorPatientSymptoms and timingECG changesCardiac markersImagingInterventionFinal cardiac diagnosisOutcome
This case45-year-old womanLeg, abdomen, and chest pain 1 month after GBS diagnosisST segment depression V1-V4, ST elevation on posterior leadsElevated troponin I levelTotal occlusion of D1 branch of LADStenting of D1 branch of LADPosterior STEMIThe patient survived
Harada []14 44-year-old womanChest pain on day 5 of GBS diagnosistransient T wave inversion in II, III, aVF, and V2 through V5NormalEchocar-diogram showed no regional wall motion abnormality. Coronary angiography with ergonovine test were normalIVIG for GBS, nitroglycerine and diltiazem for cardiac symptomsGBS-associated T wave changesThe patient survived
Cao et al []7 37-year-old womanPantalgia (generalized pain) 2 months after GBS diagnosisTransitional T wave changes in I, AVL, and V2 through V4NormalCT coronary angiography showed critical stenosis in LAD. Echocar-diogram was normalPatient refused initial intervention. Revascula-rization was done at the 2-week follow-upNon-ST segment elevated ACSNon-ST segment elevated ACS on 2-week follow-up
Kuruppuarachchi et al []21 56-year-old manChest pain as the initial presentation of autonomic variant of GBSTotal atrioven-tricular blockNormalEchocar-diogram was normal, no coronary angiographyIVIGAutonomic variant of GBSThe heart block reverted to sinus. rhythm. The patient survived
Jones et al []19 41-year-old womanChest pain on the ninth day of GBS symptoms onsetST segment elevation in leads V2-4 and ST depression in leads I and aVLNo dataCoronary angiography showed mild-moderate non-obstructive atheroma in the LAD. Ventricu-lography showed severe apical hypokinesia and ballooningIVIG for GBS; beta blocker and ACE inhibitorTakotsubo cardiomyo-pathyThe patient survived
GBS – Guillain-Barré-Syndrome; IVIG – intravenous immunoglobulin; LAD – left anterior descending artery; STEMI – ST elevation myocardial infarction.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923