BackgroundST elevation myocardial infarction is defined as acute myocardial injury with necrosis due to myocardial ischemia. The frequent cause is thrombotic occlusion of atherosclerotic coronary arteries. In particular situations, thromboembolism can cause myocardial infarction in patients with normal coronary arteries.Case presentationWe report a particular case of myocardial infarction in a young, previously healthy patient with non-atherosclerotic coronary arteries and inflammatory bowel disease. Although we performed an extensive work up, no clear pathophysiological cause could be diagnosed. Most likely, myocardial infarction was associated with a hypercoagulative state related to systemic inflammation.ConclusionThe mechanisms of coagulation disturbances in the context of acute and chronic inflammation are not yet fully understood. A better understanding of cardiovascular events in patients with inflammatory bowel disease might lead to new treatment approaches of cardiovascular disease.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12872-023-03284-x.