Acute coronary syndrome due to dilated coronaropathy in a young patient with gouty arthritis

A 39-year-old male patient with no previously known cardiovascular risk factors was admitted with angina pectoris. His medical history was unremarkable except for gouty arthritis for 3 years. He did not smoke and there was no history of alcohol use. His medications included colchicine and allopurinol. Physical examination was unremarkable. Electrocardiography revealed sinus rhythm and 1–1.5 mm ST-segment depression in the inferior leads. The biochemistry panel was normal (LDL cholesterol: 88 mg/dl). Serum uric acid was 9.5 mg/dl (N: 2.1 – 7.6 mg/dl). Cardiac biomarkers were increased during follow-up. So, coronary angiography was attempted and showed diffuse ectatic coronary arteries with no significant stenosis (Fig. 1) and a prominent slow flow in the right coronary artery (RCA). The diameter of the RCA was 15 mm (Fig. 1a), the left anterior descending artery was 10 mm and the intermediate artery was 8 mm (Fig. 1b). The hospital course was uneventful and he was discharged on warfarin, aspirin, clopidogrel, beta-blocker and statin medications. He was asymptomatic at the one- and six-month follow-up visits and also treadmill exercise testing was normal at the six-month visit.

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