Isotretinoin is widely used in the treatment of acne vulgaris and other dermatological diseases. Numerous side effects have been reported in the literature. A myocardial bridge occurs when segments of the coronary artery create an intramyocardial tunnel. Atherosclerotic plaque formation frequently occurs in the segment proximal to a myocardial bridge. Coronary thrombus formation, which is often the cause of myocardial infarction in young patients, can be triggered by many factors. Kounis syndrome is described as acute coronary syndromes associated with allergic or hypersensitivity reactions. This article is a description of the case of a patient predisposed to the development of a thrombus by a myocardial bridge who was successfully treated for coronary thrombosis and which may represent a case of Kounis syndrome associated with isotretinoin use presented in the context of the relevant literature.

Thrombotic left main coronary artery (LMCA) occlusions usually manifest as acute coronary syndrome (ACS) with cardiogenic shock, acute pulmonary edema, cardiac arrest, fatal arrhythmias or sudden cardiac death. There is no clinically predictor for LMCA thrombosis and no consensus regarding the optimal treatment. In the current literature, treatment options include emergency coronary artery bypass grafting (CABG), stent implantation, intracoronary thrombolysis, anticoagulation with heparin or glycoprotein IIb/IIIa inhibitors, thrombus aspiration as reperfusion strategies. Recently, successful results have been reported with low dose, slow infusion tPA for treatment of LMCA thrombus that allowing coronary flow. This regime may be a new treatment idea in only hemodynamically stable patients. Prospective studies and common consensus are needed about the low dose, slow infusion tPA treatment regime and optimal treatment for thrombotic LMCA obstructions. (C) 2017 Published by Elsevier B.V. on behalf of Cardiological Society of India.