tetano
Editor, Senior Moderator
Cardiovasc Pathol
. 2023 Jul 5;107558.
doi: 10.1016/j.carpath.2023.107558. Online ahead of print. Necrotizing Plasma Cell-Rich Aortitis and Sudden Cardiac Death: Late Sequelae of COVID-19?
Paul J Boor[SUP] 1 [/SUP], Mukund Srinivasan[SUP] 2 [/SUP], Heather L Stevenson[SUP] 2 [/SUP], Bin Gong[SUP] 2 [/SUP], Emmanuel Nyong[SUP] 2 [/SUP], Jianli Dong[SUP] 2 [/SUP], Vsevolod Popov[SUP] 2 [/SUP], Michael Sherman[SUP] 3 [/SUP], Nathen Bopp[SUP] 4 [/SUP], Michelle M Felicella[SUP] 2 [/SUP], Beihong Zhao[SUP] 5 [/SUP], Maximilian Buja[SUP] 5 [/SUP], Judith F Aronson[SUP] 2 [/SUP]
Affiliations
The ongoing epidemic caused by the coronavirus SARS-CoV-2 is characterized by a variety of pathologic processes within the syndrome of COVID-19. Usually beginning as an upper respiratory infection with potential progression to a pneumonitis, many cases of COVID-19 that show minimal signs or symptoms initially may develop adverse systemic sequelae later, such as widespread thrombo-embolic phenomena, systemic inflammatory disorders (especially in children), or vasculitis. Here, we present a patient who suffered a sudden cardiac death following persistent SARS-CoV-2 viral positivity for four-and-one-half months after a mild clinical viral course. At routine autopsy, a remarkable plasma cell-rich necrotizing aortitis was uncovered. The aortic intima displayed diffuse, circumferential ongoing chronic intimal edema, inflammation, and neo-vascularization. The plasma cell-rich inflammatory process also involved the origin of the left main coronary artery (LM) causing a coronary arteritis accompanied by subacute, stenosing intimal vascular smooth muscle cell (VSMC) proliferation resulting in acute myocardial necrosis as a cause of death. A similar vasculitis and plaque were noted during the routine autopsy at the ostium of the celiac artery; vasculitis was not found systemically or in smaller caliber vessels. Through a variety of techniques including extensive histopathologic and immunohistochemical characterization, immunostaining localization of viral antigen, and transmission electron microscopy we present highly suggestive evidence that this unique necrotizing, plasma cell-rich aortitis is a rare sequela of COVID-19.
Keywords: Autopsy; COVID-19; Coronary Artery; Heart; SARS-CoV-2.
. 2023 Jul 5;107558.
doi: 10.1016/j.carpath.2023.107558. Online ahead of print. Necrotizing Plasma Cell-Rich Aortitis and Sudden Cardiac Death: Late Sequelae of COVID-19?
Paul J Boor[SUP] 1 [/SUP], Mukund Srinivasan[SUP] 2 [/SUP], Heather L Stevenson[SUP] 2 [/SUP], Bin Gong[SUP] 2 [/SUP], Emmanuel Nyong[SUP] 2 [/SUP], Jianli Dong[SUP] 2 [/SUP], Vsevolod Popov[SUP] 2 [/SUP], Michael Sherman[SUP] 3 [/SUP], Nathen Bopp[SUP] 4 [/SUP], Michelle M Felicella[SUP] 2 [/SUP], Beihong Zhao[SUP] 5 [/SUP], Maximilian Buja[SUP] 5 [/SUP], Judith F Aronson[SUP] 2 [/SUP]
Affiliations
- PMID: 37419163
- DOI: 10.1016/j.carpath.2023.107558
The ongoing epidemic caused by the coronavirus SARS-CoV-2 is characterized by a variety of pathologic processes within the syndrome of COVID-19. Usually beginning as an upper respiratory infection with potential progression to a pneumonitis, many cases of COVID-19 that show minimal signs or symptoms initially may develop adverse systemic sequelae later, such as widespread thrombo-embolic phenomena, systemic inflammatory disorders (especially in children), or vasculitis. Here, we present a patient who suffered a sudden cardiac death following persistent SARS-CoV-2 viral positivity for four-and-one-half months after a mild clinical viral course. At routine autopsy, a remarkable plasma cell-rich necrotizing aortitis was uncovered. The aortic intima displayed diffuse, circumferential ongoing chronic intimal edema, inflammation, and neo-vascularization. The plasma cell-rich inflammatory process also involved the origin of the left main coronary artery (LM) causing a coronary arteritis accompanied by subacute, stenosing intimal vascular smooth muscle cell (VSMC) proliferation resulting in acute myocardial necrosis as a cause of death. A similar vasculitis and plaque were noted during the routine autopsy at the ostium of the celiac artery; vasculitis was not found systemically or in smaller caliber vessels. Through a variety of techniques including extensive histopathologic and immunohistochemical characterization, immunostaining localization of viral antigen, and transmission electron microscopy we present highly suggestive evidence that this unique necrotizing, plasma cell-rich aortitis is a rare sequela of COVID-19.
Keywords: Autopsy; COVID-19; Coronary Artery; Heart; SARS-CoV-2.