Myocardial Infarction as an Initial Presentation of Essential Thrombocythemia With Calreticulin (CALR) Mutation (None Type 1, None Type 2)

Abstract

Essential thrombocythemia (ET) is one of the classical Philadelphia-negative myeloproliferative neoplasms with different mutations that can be associated with it, like Janus kinase 2 (JAK2), myeloproliferative leukemia protein (MPL), and Calreticulin (CALR) (types 1 and 2). However, there is a lack in the literature concerning other types of CALR mutations and their clinical significance and prognosis. Here we report a 42-year-old male with type 2 diabetes who presented with an inferior ST-elevation myocardial infarction and thrombocytosis. The diagnosis of ET with CALR (neither type 1 nor type 2) was confirmed, which suggests the pathognomonic feature of this mutation.

Structural and Dynamic Differences between Calreticulin Mutants Associated with Essential Thrombocythemia

“…These results are important as ET is associated with a large number of complications [ 9 ], and it remains difficult to associate the clinical significance with the prognoses of the different CALR types [ 90 , 91 ]. Herein, we underlined that these types must also be carefully taken into consideration.…”

Acute myocardial infarction in myeloproliferative neoplasms

“…The peripheries do not show edema, but erythromelalgia of the hands is positive in some cases[ 33 ]. Lab tests reveal elevated platelets, troponins, D-dimers, triglycerides and hematocrit with low potassium levels and normal urea, electrolytes, and creatinine[ 35 , 36 ].…”

“…Notably, as part of treatment, an oral imidazoquinazoline drug, anagrelide, has been observed to cause ACS in some (1%-5%) patients with ED by directly inducing coronary artery vasospasm[ 4 ]. The incidence of ACS increases with increasing age; therefore, most of the presenting patients are over 60 years of age and those with a history of thrombosis or in the background of mutations in the JAK2 or MPL genes[ 35 ].…”