A rare cause of non-cardiac troponin elevation: acute cholecystitis; case report

Objective: Cardiac troponins are accepted as the standard markers for diagnosis and risk management of patients with acute coronary syndromes. However, cardiac troponins are elevated in some patients presenting with non-cardiac situations. In this paper, a rare case of non-cardiac troponin elevation with acute cholecystitis is presented.
Case: A 56 year old female patient admitted to the emergency room with pain in the epigastric region. The abdominal ultrasound revealed acute cholecystitis. She had some coronary risk factors and electrocardiogram showed no segment deviation but troponin was positive. Acute coronary syndrome couldn’t be ruled out and coronary angiography revealed normal coronary arteries. Therefore, elevated troponin was linked to acute cholecystitis.
Conclusion: Although troponin elevation is a cornerstone marker for diagnosis the patients with acute coronary syndromes, there are various conditions with non-coronary-related troponin elevations. This can lead to misdiagnosis and unnecessary interventions. As a result, in patients with similar sypmtoms (pain in the epigastric region), electrocardiogram wave changes and elevated troponin levels, acute cholesystitis diagnosis should be considered.

Nadir görülen non-kardiyak troponin yüksekliði nedeni: Akut kolesistit; olgu sunumu

Amaç: Kardiyak troponinler miyokard infarktüsünün taný ve risk deðerlendirilmesinde standart belirteçler olarak kabul edilmiþtir. Ancak kardiyak troponinler akut koroner sendrom dýþý nedenle baþvuran bazý hastalarda da yüksek bulunmaktadýr. Burada nadir görülen bir kardiyak dýþý troponin yüksekliði akut kolesistit vakasý sunulmuþtur.
Olgu: Acil servise epigastrik bölgede aðrý ile baþvuran 56 yaþýnda bayan hastanýn yapýlan batýn ultrasonografide akut kolesistit lehine bulgular izlendi. Koroner arter hastalýðý açýsýndan risk faktörleri olan hastanýn elektrokardiyografi bulgularý normal olmakla birlikte bakýlan troponin pozitif saptandý. Akut koroner sendrom ekarte edilemeyen hastanýn yapýlan koroner anjiyografisinde koroner arterleri normal saptandý ve hastadaki troponin yüksekliði akut kolesistite baðlandý.
Sonuç: Troponin yüksekliði akut koroner sendromlarda bir belirteç olarak kullanýlsa da, akut koroner sendrom dýþý nedenle baþvuran bazý hastalarda da yüksek bulunmaktadýr. Bu durum yanlýþ tanýlara ve gereksiz giriþimlere yol açabilmektedir. Sonuç olarak benzer semptomlarý olan (epigastrik bölgede aðrý), elektrokardiyografide deðiþiklikleri olan ve troponin yüksekliði olan hastalarda akut kolesistit
tanýsý akýlda tutulmalýdýr.