Abstract
RATIONALE: Methanol poisoning is a rare but potentially fatal condition characterized by metabolic acidosis, neurological dysfunction, and visual impairment. Acute myocardial infarction caused by coronary artery spasm as a complication of methanol poisoning is extremely rare and has seldom been reported in the literature. PATIENT CONCERNS: A 46-year-old male presented to the emergency department with acute chest pain, dyspnea, dizziness, and blurred vision lasting for 4 hours. He had no prior history of cardiovascular diseases but reported potential occupational exposure to methanol vapors during pyrotechnic bright bead production 2 days prior to symptom onset. DIAGNOSES: The patient demonstrated ST-segment elevation in the inferior leads on the electrocardiogram, accompanied by elevated cardiac biomarkers, indicative of an acute myocardial infarction. Furthermore, the patient presented with severe metabolic acidosis and visual disturbances, with a blood methanol concentration of 823 μg/mL, confirming a diagnosis of methanol poisoning. INTERVENTIONS: Coronary angiography identified a total occlusion in the mid-segment of the right coronary artery, which was effectively managed through balloon angioplasty and the administration of intracoronary nitroglycerin. Continuous renal replacement therapy was commenced to rectify metabolic acidosis and facilitate the removal of methanol and its toxic metabolites. Fomepizole was not used due to regional unavailability and ethanol was not administrated due to its cardiovascular risks. To address visual impairment, neuroprotective agents were administered in conjunction with glucocorticoids. OUTCOMES: Subsequent to the interventions, the patient's chest pain and dyspnea were promptly alleviated, while the diminished visual acuity showed gradual improvement. The patient was discharged on the 12th day post-admission and exhibited continued recovery of visual function at the 1-month follow-up. LESSONS: This case underscores the critical importance of recognizing the potential cardiovascular complications of methanol poisoning. Severe metabolic acidosis induced by methanol intoxication may serve as an important contributing factor for coronary artery spasm. Timely recognition of clinical symptoms and comprehensive multidisciplinary management strategies are vital to improving patient outcomes.