Acute Myocardial Infarction in a 13-Year-Old Boy after Bone Marrow Transplantation

Published:September 13, 2022DOI:



      Advances in bone marrow transplantation (BMT) present a unique opportunity for treating leukemia in children. It has also increased the risk of long-term complications in the lungs, genitourinary tract, and nervous system. Coronary artery disease is the most common type of heart disease in older adults, but is not generally acknowledged as a complication of BMT, especially in young patients.

      Case Report

      We report the occurrence of acute myocardial infarction in a 13-year-old boy, approximately 5 years after he received a half-matched related bone marrow transplant from his father for T-cell lymphoblastic leukemia. Acute myocarditis was suspected early in the clinical course on the basis of his age and clinical presentations, such as atypical chest pain and dyspnea. Follow-up coronary angiography revealed a total occlusion of the right coronary artery, as well as diffused lesions of the left main, anterior descending, and circumflex branch. Fortunately, he was discharged from the hospital in satisfactory general condition after complex treatment.
      Why Should An Emergency Physician Be Aware of This? In this case, its rarity and poor clinical recognition were the main reasons for delayed diagnosis, which led to a delay to coronary angiography. Given the high mortality in cardiovascular complications among BMT recipients, the correct diagnostic assessment in such cases becomes particularly relevant.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • de Ferranti SD
        • Steinberger J
        • Ameduri R
        • et al.
        Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association.
        Circulation. 2019; 139: e603-e634
        • Flynn JT
        • Kaelber DC
        • Baker-Smith CM
        • et al.
        Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.
        Pediatrics. 2017; 140e20171904
        • Lui GK
        • Fernandes S
        • McElhinney DB.
        Management of cardiovascular risk factors in adults with congenital heart disease.
        J Am Heart Assoc. 2014; 3e001076
        • Inaba H
        • Mullighan CG.
        Pediatric acute lymphoblastic leukemia.
        Haematologica. 2020; 105: 2524-2539
        • Barrett J
        • Craddock C.
        Bone marrow transplantation in the United Kingdom - past, present and future.
        Br J Haematol. 2020; 191: 612-616
        • Hilgendorf I
        • Greinix H
        • Halter JP
        • Lawitschka A
        • Bertz H
        • Wolff D.
        Long-term follow-up after allogeneic stem cell transplantation.
        Dtsch Arztebl Int. 2015; 112: 51-58
        • Caforio AL
        • Pankuweit S
        • Arbustini E
        • et al.
        Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases.
        Eur Heart J. 2013; 34 (48a–d): 2636-2648
        • Brothers JA
        • Gaynor JW
        • Jacobs JP
        • Poynter JA
        • Jacobs ML.
        The Congenital Heart Surgeons' Society Registry of Anomalous Aortic Origin of a Coronary Artery: an update.
        Cardiol Young. 2015; 25: 1567-1571
        • Sumi M
        • Kitahara M
        • Shishido T
        • et al.
        Myocarditis with advanced atrioventricular block after allogeneic stem cell transplantation: a case report and literature review.
        Intern Med. 2020; 59: 113-118
        • Chan KW
        • Taylor GP
        • Shepherd JD
        • Shepherd WE.
        Coronary artery disease following bone marrow transplantation.
        Bone Marrow Transplant. 1989; 4: 327-330
        • Cazin B
        • Gorin NC
        • Laporte JP
        • et al.
        Cardiac complications after bone marrow transplantation. A report on a series of 63 consecutive transplantations.
        Cancer. 1986; 57: 2061-2069
        • Lee PJ
        • Mallik R.
        Cardiovascular effects of radiation therapy: practical approach to radiation therapy-induced heart disease.
        Cardiol Rev. 2005; 13: 80-86
        • Zeiser R
        • Blazar BR.
        Pathophysiology of chronic graft-versus-host disease and therapeutic targets.
        N Engl J Med. 2017; 377: 2565-2579
        • Tichelli A
        • Gratwohl A.
        Vascular endothelium as 'novel' target of graft-versus-host disease.
        Best Pract Res Clin Haematol. 2008; 21: 139-148
        • Ghobrial IM
        • Bunch TJ
        • Caplice NM
        • Edwards WD
        • Miller DV
        • Litzow MR.
        Fatal coronary artery disease after unrelated donor bone marrow transplantation.
        Mayo Clin Proc. 2004; 79: 403-406
        • Graze PR
        • Gale RP.
        Chronic graft versus host disease: a syndrome of disordered immunity.
        Am J Med. 1979; 66: 611-620
        • Armenian SH
        • Sun CL
        • Vase T
        • et al.
        Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease.
        Blood. 2012; 120: 4505-4512
        • Cheng RK
        • Lee MS
        • Seki A
        • et al.
        Radiation coronary arteritis refractory to surgical and percutaneous revascularization culminating in orthotopic heart transplantation.
        Cardiovasc Pathol. 2013; 22: 303-308
        • Simmonds J
        • Fenton M
        • Dewar C
        • et al.
        Endothelial dysfunction and cytomegalovirus replication in pediatric heart transplantation.
        Circulation. 2008; 117: 2657-2661
        • Huang S
        • Martin P
        • Campbell MJ.
        Coronary artery occlusion secondary to graft versus host disease after bone marrow transplant in a 21-year-old.
        Cardiol Young. 2018; 28: 1484-1486