Inflammatory coronary arteritis complicated by myocardial infarction: an exceptional manifestation of systemic sclerosis

Abstract Systemic sclerosis is a rare autoimmune connective tissue disease characterized by progressive fibrosis and widespread microvascular involvement. Although cardiac involvement is relatively common, it frequently remains clinically silent and underdiagnosed. We report an exceptional case of inflammatory coronary arteritis revealing systemic sclerosis, complicated by an acute myocardial infarction in a 64-year-old woman with no cardiovascular risk factors. Coronary angiography revealed thrombotic occlusion without any atherosclerotic lesions, suggesting a non-atherosclerotic etiology. The subsequent development of pericarditis and joint pain, combined with positive immunological markers (anti-Scl70 and anti-RNA polymerase III antibodies), led to the diagnosis of systemic sclerosis. Immunosuppressive therapy resulted in significant clinical improvement. This case underscores the importance of considering inflammatory etiologies in atypical acute coronary syndromes, particularly in the absence of traditional risk factors, and highlights the need for an integrated diagnostic approach in systemic inflammatory contexts.