• Martin Rebolledo Del Toro, Camila Borda, Luisa Fernanda Rincón, Andrea Castillo, and Daniel Gerardo Fernández-Ávila.
• Pontificia Universidad Javeriana Departmento de Medicina Interna, Bogota, Colombia.
• Colomb Medica. 2023 Apr 1; 54 (2): e5005466e5005466.

Case DescriptionA 61-year-old male patient with uncontrolled rheumatoid arthritis presented acute coronary syndrome on three occasions, less than 48 hours after infliximab infusion.Clinical FindingsHe presented with ST-elevation myocardial infarction on two occasions and non-ST-elevation acute coronary syndrome on one, with the identification of multivessel coronary disease.Treatment And OutcomeCoronary intervention was performed with thrombus aspiration, medicated stent implantation, medicated balloon angioplasty, discontinuation of infliximab, and modification and optimization of cardiovascular pharmacological management.Clinical RelevancePatients with rheumatoid arthritis have subclinical cardiovascular disease and increased cardiovascular risk. The evidence regarding the relationship between infliximab and ischemic heart disease is controversial. A wide clinical spectrum of cardiac involvement with infliximab infusion is found in case reports, ranging from stable angina to ST-segment elevation acute coronary syndrome. The pathophysiology is not elucidated, with hypotheses proposing plaque rupture, allergic reactions, and vasoconstriction as possible disease mechanisms. The direct association between infliximab infusion and acute coronary syndrome needs more clinical research to optimize the management and prognosis of patients presenting with this type of complication.Copyright © 2023 Colombia Medica.

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