Cardiovascular involvement is common in rheumatoid arthritis . Pericarditis, cardiomyopathy, myocarditis, cardiac amyloidosis, coronary vasculitis, arrhythmias, valvular heart disease and congestive heart failure due to ischemia can be seen in addition to the classical extra-articular involvement . Patients with rheumatoid arthritis are under risk of accelerated atherosclerosis and myocardial infarction due to increased inflammation. Endothelial dysfunction is an important mechanism for thrombosis in these patients . Pro-inflammatory cytokines (interleukin-1 beta and tumor necrosis factor alpha, C-reactive protein), activated coagulation factors (tissue factor, von Willebrand factor and plasminogen activator inhibitor-1), increased activity of cell adhesion molecules (selectins, vascular adhesion molecule-1, intercellular adhesion molecule-1) and matrix metalloproteinases are responsible for this endothelial dysfunction leading thrombosis . The risk is especially higher in patients who have used or are using glucocorticoids . In patients with Cushing’s syndrome due to chronic steroid use, accumulation of cardio-metabolic risk factors like visceral obesity, hypertension, hyperglycemia and hyperlipidemia results in acceleration of cardiovascular disease . Additionally, a hypercoagulability state was also detected in patients with endogenous Cushing’s syndrome . Herein we present a patient with rheumatoid arthritis who had extensive coronary thrombosis and was given steroid therapy for a long time.