ST-elevation myocardial i...

A 35-year-old male patient was admitted to the emergency department due to severe, progressive chest pain that started 3 hours prior. He experienced excruciating pain radiating to the left axilla and shoulder. The patient had a history of gingival bleeding while brushing his teeth three days before this presentation. On examination, the patient was diaphoretic and in acute distress due to chest pain. His ECG revealed ST elevation in anterior and lateral leads, which is diagnostic of ST-elevated myocardial infarction (STEMI) (Fig 1). He had an elevated creatine kinase-MB level (measured at 112 IU/L) and tested positive for Troponin T. Additionally, his CBC showed a leukocyte count of 234,000 cells/µL a peripheral blood smear showed 80% blasts that were myeloperoxidase positive. Lactate dehydrogenase was measured at 1236 U/L. A bone marrow biopsy and flow cytometry was performed (Fig 2 and Fig 3). After thrombolysis, the patient's subsequent ECG did not show ST elevation resolution, and chest pain persisted. The coronary angiogram was unremarkable, except for mild luminal narrowing of the left anterior descending coronary artery.