Myocardial Dysfunction and Left Ventricular Thrombus in a Young Thalassemia Patient with Diabetic Ketoacidosis: A Rare Case Report

Abstract A 20-year-old male with a history of β-thalassemia major presented with altered sensorium, abdominal pain, and rapid breathing. He was recently diagnosed with diabetes mellitus, likely secondary to iron overload due to poor compliance with chelation therapy. On admission, he was found to be in diabetic ketoacidosis (DKA). During management, the patient developed recurrent supraventricular tachycardia (SVT) and hypotension. Cardiac evaluation revealed regional wall motion abnormalities in the anterolateral wall, left ventricular ejection fraction of 40%, elevated troponin I, and a large apical thrombus measuring 2.5 × 1.5 cm. The patient subsequently went into cardiogenic shock with concurrent sepsis. Intensive care management included insulin infusion, electrolyte correction, inotropic support, anticoagulation, antiarrhythmic therapy, and broad-spectrum antibiotics. Gradual stabilization was achieved, with partial resolution of the thrombus and improved cardiac function on follow-up echocardiography. This case underscores the devastating impact of iron overload and non-compliance to chelation in thalassemia patients, leading to multi-organ complications including endocrine dysfunction, DKA, and severe cardiac disease. Early recognition and multidisciplinary management are vital to improve outcomes in such complex scenarios.