Chan WJ, Tan TXZ, Ponampalam R, Thompson A. Thrombotic storm presenting with synchronous myocardial infarction, stroke and bowel ischaemia: A case report. World J Crit Care Med 2025; 14(4): 109786 [DOI: 10.5492/wjccm.v14.i4.109786]
Corresponding Author of This Article
Wen-Jian Chan, Department of Emergency Medicine, SingHealth, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. chan.wenjian@gmail.com
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Critical Care Medicine
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Dec 9, 2025
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Publication Name
World Journal of Critical Care Medicine
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2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Chan WJ, Tan TXZ, Ponampalam R, Thompson A. Thrombotic storm presenting with synchronous myocardial infarction, stroke and bowel ischaemia: A case report. World J Crit Care Med 2025; 14(4): 109786 [DOI: 10.5492/wjccm.v14.i4.109786]
World J Crit Care Med. Dec 9, 2025; 14(4): 109786 Published online Dec 9, 2025. doi: 10.5492/wjccm.v14.i4.109786
Thrombotic storm presenting with synchronous myocardial infarction, stroke and bowel ischaemia: A case report
Wen-Jian Chan, Timothy Xin Zhong Tan, R Ponampalam, Arjun Thompson
Wen-Jian Chan, Timothy Xin Zhong Tan, Department of Emergency Medicine, SingHealth, Singapore General Hospital, Singapore 169608, Singapore
R Ponampalam, Arjun Thompson, Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
Co-first authors: Wen-Jian Chan and Timothy Xin Zhong Tan.
Author contributions: Chan WJ and Tan TXZ did the literature review and wrote the manuscript; Ponampalam R and Thompson A provided edits and contributed resources; all authors have read and approved the final manuscript.
Informed consent statement: The patient remained unconscious throughout his admission till subsequent demise and could not provide consent. He had no contactable family/next of kin to give consent as well. As such, consent could not be obtained from this patient.
Conflict-of-interest statement: The authors managed the patient during his initial illness and inpatient stay, but otherwise have no financial or personal conflicts of interest to declare
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Jian Chan, Department of Emergency Medicine, SingHealth, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. chan.wenjian@gmail.com
Received: May 22, 2025 Revised: June 17, 2025 Accepted: August 20, 2025 Published online: December 9, 2025 Processing time: 191 Days and 9.4 Hours
Core Tip
Core Tip: This case describes the first known instance of simultaneous myocardial infarction, stroke, and bowel infarction, likely due to a thrombotic crisis. Synchronous cardiocerebral infarcts are rare (0.009%–0.29%) and typically affect older males. Etiology remains unclear but may involve cardiogenic shock reducing cerebral perfusion. Management requires a multidisciplinary approach. If within the thrombolysis window (4.5 hours), IV recombinant tissue plasminogen activator (0.9 mg/kg) should be given first, followed by coronary intervention. Outside this window, treatment prioritization depends on hemodynamic stability—cardiac intervention for shock, stroke management otherwise. Post-acute care involves high-dose statins if atherosclerosis is suspected and close monitoring in a high-acuity setting.
