ST elevation myocardial infarction as presenting feature of C-ANCA vasculitis: A case of a diagnostic dilemma

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Although uncommon, it should be included in the differential diagnosis for middle-aged patients without elevated atherosclerotic vascular disease risk or a family history of cardiovascular disease. SCAD is associated with postpartum women; however, reports noting its association with autoimmune disease and vasculopathy in other populations have recently gained prominence. We report a case of a 41-year-old male who was found to have SCAD after presenting with ST segment elevation myocardial infarction in the context of episodic vision loss, and who later underwent work-up for C-ANCA vasculitis and was successfully treated with corticosteroids. LEARNING POINTS • SCAD is most common in middle-aged females. However, it can present in male patients, and it should raise suspicion of underlying vasculopathy. • Eosinophilic vasculitis may mimic parasitic infection. • C-ANCA vasculitis can be associated with SCAD.