Journal of Case Reports and Images in Oncology, Volume 8, Issue 2, 2022. ISSN: 2582-1318 J Case Rep Images Oncology 2022;8(2):5–10. www.ijcrioncology.com Bassi et al. 5 CASE REPORT OPEN ACCESS A case study of successful percutaneous coronary intervention in a young adult with chronic graft-versus-host disease with acute coronary syndrome Sunakshi Bassi, Addison Gearhart, David Liddle, Pinak B Shah, Jacob Hartz, Jesse Esch ABSTRACT Introduction: Acute coronary syndrome in pediatric patients with graft-versus-host disease is rare. Case Report: We present an 18-year-old male with graft-versus-host disease referred for chest pain, electrocardiogram abnormalities, and troponin leak. Additional risk factors for acute coronary syndrome included chronic steroid use, elevated triglyceride/ low-density lipoprotein (LDL) levels and cannabis use. A catheterization revealed >90% occlusion of the left coronary artery and he underwent successful percutaneous intervention. Conclusion: Given the overall rarity of acute coronary syndrome in pediatric patients, it may go unrecognized and underappreciated as a significant cause of morbidity in those with graft-versus-host disease. Keywords: Acute coronary syndrome, Case report, Graft-versus-host disease, Pediatrics Sunakshi Bassi 1,* , MD, MHS, Addison Gearhart 1,2,* , MD, Da- vid Liddle 1,2 , MD, Pinak B Shah 3 , MD, Jacob Hartz 1,2 , MD, MPH, Jesse Esch 1,2 , MD Affiliations: 1 Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; 2 Department of Cardiol- ogy, Boston Children’s Hospital, Boston, MA 02115, USA; 3 Department of Cardiology, Brigham and Women’s Hospital, Boston, MA 02115, USA. Corresponding Author: Sunakshi Bassi, 300 Longwood Ave, Boston, MA 02115, USA; Email: sunakshi.bassi@childrens. harvard.edu Received: 12 May 2022 Accepted: 04 July 2022 Published: 21 August 2022 CASE REPORT PEER REVIEWED | OPEN ACCESS How to cite this article Bassi S, Gearhart A, Liddle D, Shah PB, Hartz J, Esch J. A case study of successful percutaneous coronary intervention in a young adult with chronic graft- versus-host disease with acute coronary syndrome. J Case Rep Images Oncology 2022;8(2):5–10. Article ID: 100108Z10SB2022 ********* doi: 10.5348/100108Z10SB2022CR INTRODUCTION Graft-versus-host disease (GVHD) is a well- known and frequent complication of allogenic hematopoietic stem cell transplant (HSCT), leading to significant morbidity and mortality [1]. Intra-cardiac manifestations of GVHD in pediatric patients, however, are rare and not well described in the literature [2]. When cardiac complications do occur in these patients, they are typically secondary to chemotherapy toxicity, direct radiation exposure to the chest, immune- mediated therapies, or infections. Thus far, only three cases of suspected acute coronary syndrome (ACS) secondary to GVHD have been reported in the literature in pediatric patients [3–5]. Only one of these cases resulted in percutaneous coronary intervention (PCI), while the others resulted in mortality. To the best of our knowledge, we present a second case of suspected ACS secondary to cardiac GVHD in a pediatric patient who underwent successful PCI. * These authors contributed equally to the manuscript.