Vol. 7, Issue 2, Part A (2025)

Background: Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome predominantly affecting young women. While various precipitating factors have been identified, viral infections as triggers for SCAD remain extremely rare, with Japanese encephalitis (JE) never previously reported as a causative factor.

Case Summary: We report a 53-year-old diabetic male smoker who developed multivessel SCAD following recovery from JE viral meningoencephalitis. The patient initially presented with high-grade fever and altered mental status with positive neck rigidity. CSF examination confirmed viral meningoencephalitis with positive JE virus testing. Following recovery from the acute neurological syndrome, the patient developed NYHA Class III dyspnea. Cardiac evaluation revealed elevated cardiac biomarkers (troponin 0.04 ng/mL, BNP 800 pg/mL), left bundle branch block, and severely reduced ejection fraction (30%) with global left ventricular hypokinesis1. Coronary angiography demonstrated extensive multivessel SCAD involving proximal LAD with long-segment dissection and distal subtotal occlusion, non-flow limiting dissection in major obtuse marginal, and flow-limiting dissection causing 90% stenosis in proximal RCA. Viability testing revealed non-viable myocardium in LAD territory and mixed viability in LCx and RCA territories. Comprehensive workup for traditional SCAD etiologies including autoimmune markers, genetic testing, and fibromuscular dysplasia screening was negative.

Conclusion: This represents the first reported case of JE-induced SCAD, expanding our understanding of viral infections as precipitating factors for coronary artery dissection. The temporal relationship between viral encephalitis and subsequent cardiac presentation, combined with absence of other identifiable risk factors, strongly suggests a causal relationship through inflammatory or direct viral mechanisms.