The coronavirus disease 2019 (COVID-19) is a highly contagious novel infection that predominantly presents with fever and respiratory symptoms. However, COVID-19 can masquerade as an acute coronary syndrome, leg pain or swelling with venous thrombosis, loss of consciousness with cerebral venous thrombosis, confusion, limb weakness with brain infarction, facial neuralgia, acute conjunctivitis, acute appendicitis, and testicular pain. We report on a 42-year-old man who presented with mild symptoms of COVID-19. The patient's electrocardiogram showed an ST-segment elevation myocardial infarction (STEMI) due to a left coronary thrombosis. The patient was managed conservatively with medicines and had an uneventful recovery. Emergency physicians should have a high index of suspicion for the unusual presentations of COVID-19.

Kawasaki disease (KD) is a systemic vasculitis of unknown cause which usually diagnosed in small children. However, KD can be present as coronary disease in adults even with no history of the disease in childhood. Here, we describe a case of KD in a 42-year-old male patient presented with severe retrosternal chest pain radiating to the left arm and provisionally diagnosed as acute coronary disease. Coronary artery ectasia and multiple aneurysms have been confirmed by coronary angiography that led to the diagnosis of KD. The patient was treated with Aspirin 81 mg orally once daily, Apixapan 5 mg orally twice daily, Rosuvastatin 40 mg orally once daily, Bisoprolol 5 mg orally once daily, and omeprazole 20 mg orally once daily. The patient was improved and discharged with anticoagulant drugs for life. Physicians should be aware that KD can be present as coronary disease in adults even with no history of the disease in childhood and has a limited treatment options due to unfavorable coronary anatomy. doi: https://doi.org/10.12669/pjms.37.7.4199 How to cite this:Haider KH, Alshoabi SA, Qurashi AA, Hamid AM. Incidentally discovered Kawasaki disease in an adult man. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4199 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background There is a paucity of information about the clinical features and angiographic findings in young patients with acute myocardial infarction (MI), especially in the Arab Peninsula countries. Objective The aim of this study was to assess the proposed risk factors, clinical presentation, and angiographic findings of acute myocardial infarction in young adults. Methods This prospective study included young (range, 18 to 45 years) patients who presented with acute MI based on clinical evaluation, laboratory investigation, and electrocardiogram, and they underwent a coronary angiography procedure. Key findings Data of 109 patients with a diagnosis of acute MI were collected. Patients’ mean age was 39.98 ± 7.52 years (range, 31 to 45 years), and 92.7% (101) were male. Smoking was the highest risk factor in 67% of patients, obesity and overweight in 66%, sedentary lifestyle in 64%, dyslipidaemia in 33%, and hypertension in 28%. Smoking was the most common risk factor for acute MI in males (p = 0.009), whereas sedentary lifestyle was the most common risk factor in females (p = 0.028). Chest pain typical of acute MI was the most common presenting symptom in 96% of patients (p < 0.001). On admission, 96% of patients were conscious, and 95% were oriented. On angiography, the left anterior descending artery (LAD) was affected in 57%, the right coronary artery (RCA) was affected in 42%, and the left circumflex artery (LCX) was affected in 32% of patients. The LAD was severely affected in 44%, the RCA was severely affected in 25.7%, and the LCX was severely affected in 19.26% of patients (p < 0.001). Conclusion Smoking, obesity, sedentary lifestyle, dyslipidaemia, and hypertension were the most common risk factors for acute MI. Smoking was the most common risk factor in males and sedentary lifestyle in females. The LAD was the most commonly affected coronary artery, followed by the RCA and LCX arteries, with the same order for severity of stenosis.