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We describe the case of a 47-year-old man who suddenly developed a complete atrioventricular block and an episode of cardiac arrest while undergoing treatment for sepsis secondary to invasive group A streptococci. Emergency coronary angiography and provocation revealed spasm of the right coronary artery, which had led to the atrioventricular block. The spasm was relieved following administration of calcium-channel blockade, and no subsequent recurrence was documented. Due to several underlying mechanisms, sepsis may be a potential risk factor of coronary spasm and episodes of this condition have been missed or misdiagnosed. Physicians should be aware of CSA as a potential complication during treatment of sepsis.<\/jats:p>","DOI":"10.1136\/bcr-2021-244693","type":"journal-article","created":{"date-parts":[[2021,8,23]],"date-time":"2021-08-23T12:57:44Z","timestamp":1629723464000},"page":"e244693","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Rare case of coronary spastic angina during treatment of invasive group A streptococcal sepsis"],"prefix":"10.1136","volume":"14","author":[{"given":"Tatsuya","family":"Sakagami","sequence":"first","affiliation":[{"name":"Department of Emergency, Tokyo Kita Medical Center, Kita-ku, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Tsuji","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokyo Kita Medical Center, Kita-ku, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,23]]},"reference":[{"key":"2025082723470540000_14.8.e244693.1","doi-asserted-by":"publisher","DOI":"10.1272\/jnms.78.4"},{"key":"2025082723470540000_14.8.e244693.2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a014996"},{"key":"2025082723470540000_14.8.e244693.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.78.1.1"},{"key":"2025082723470540000_14.8.e244693.4","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.87.1.76"},{"key":"2025082723470540000_14.8.e244693.5","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)00381-Y"},{"key":"2025082723470540000_14.8.e244693.6","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.50.3.534"},{"key":"2025082723470540000_14.8.e244693.7","article-title":"Recurrent ST elevation myocardial infarction from norepinephrine-induced coronary vasospasm","volume":"12","author":"Qarajeh","year":"2020","journal-title":"Cureus"},{"key":"2025082723470540000_14.8.e244693.8","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.74.2.262"},{"key":"2025082723470540000_14.8.e244693.9","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(88)92598-3"},{"key":"2025082723470540000_14.8.e244693.10","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.94.3.266"},{"key":"2025082723470540000_14.8.e244693.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0008-6363(99)00144-3"},{"key":"2025082723470540000_14.8.e244693.12","first-page":"30","article-title":"Involvement of Rho kinase (ROCK) in sepsis-induced acute lung injury","volume":"4","author":"Cinel","year":"2012","journal-title":"J Thorac Dis"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-244693","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:47:14Z","timestamp":1756363634000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-244693"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":12,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,23]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bcr-2021-244693"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-244693","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}