The dual crisis of coronary thrombosis and sepsis in JAK2-mutated essential thrombocytosis: A clinical case report

Rationale: Essential thrombocytosis (ET) is a myeloproliferative neoplasms (MPNs) primarily caused by JAK2 gene mutations. The condition is characterized by thrombosis or hemorrhage as its main complications, with infection posing a significantly elevated risk of mortality. The dual crisis of acute myocardial infarction and sepsis occurring simultaneously is extremely rare but fatal. Identifying and properly managing these rare yet severe complications is of paramount importance. This case report aims to emphasize the importance of timely identification of primary thrombocytosis and correct intervention of acute myocardial infarction and sepsis complications, especially early coronary angiography stent placement, anticoagulation-hemorrhage and sepsis management, which can not only improve patient prognosis but also effectively reduce the risk of death. Diagnoses: A 79-year-old female patient presented with palpitations and abdominal pain. An electrocardiogram showed ST-segment elevation in the inferior and anterior walls, indicating a ST-segment elevation myocardial infarction (STEMI). The elevated white blood cell count (36.92 × 10 9 /L) and procalcitonin (PCT) level (6.26 ng/mL) indicated septicemia markers, while imaging studies revealed intestinal gas accumulation and ascites; sepsis was confirmed. The platelet count peaked at 1357 × 10 9 /L, and genetic testing for MPNs revealed an 80% mutation in JAK2 V617F, ET was confirmed. Interventions: Emergency coronary stent implantation was performed, along with piperacillin-tazobactam antibiotic therapy and controlled fluid resuscitation. Treatment included antiplatelet therapy, anticoagulation therapy, and hydroxyurea. Outcomes: The patient’s condition improved, with complete disappearance of symptoms of palpitations and abdominal pain, normal infection indicators, and smooth discharge. One month later, the platelet decreased to 439 × 10 9 /L, and no bleeding or thrombosis complications occurred. Lessons: This case suggests that JAK2 gene testing should be conducted for unexplained thrombocytosis; occult infection must be investigated when myeloproliferative neoplasm patients develop leukocytosis; maintaining therapeutic balance is crucial in the dual crisis of thrombosis and sepsis.