A Case Report of Spontaneous Coronary Artery Dissection in Pregnancy: A Challenging Diagnosis.

Lemierre's syndrome and spontaneous coronary artery dissection (SCAD) are rare and potentially life-threatening conditions that seldom occur concurrently. Lemierre's syndrome typically presents as septic thrombophlebitis of the internal jugular vein following an oropharyngeal infection, while SCAD is a non-atherosclerotic tear in the coronary artery wall, often associated with pregnancy. The co-occurrence of these two conditions is exceedingly rare and presents complex diagnostic and management challenges, particularly in pregnant patients. We describe a case of a 36-year-old woman at 22 weeks of gestation who presented with a three-day history of left-sided neck pain, chest pain, and shortness of breath. Initial workup included an electrocardiogram, which showed nonspecific T-wave changes, serial troponin measurements that revealed a rising trend, and a duplex ultrasound of the neck, which revealed an intramural hematoma in the coronary arteries suggestive of SCAD, along with an occlusive thrombus in the left internal jugular vein consistent with Lemierre's syndrome. This case highlights a rare overlap of SCAD and Lemierre's syndrome in pregnancy. Hormonal and hemodynamic changes likely contributed to both conditions. Treatment required careful balancing of anticoagulation risks and benefits. To our knowledge, this is one of the first reported cases of concurrent SCAD and Lemierre's syndrome in a pregnant patient. It underscores the need for vigilant assessment and coordinated care in rare, high-risk vascular presentations during pregnancy.