Necrotizing plasma cell-rich aortitis and sudden cardiac death: Late sequelae of COVID-19?

Paul J. Boor, Mukund Srinivasan, Heather L. Stevenson, Bin Gong, Emmanuel Nyong, Jianli Dong, Vsevolod Popov, Michael Sherman, Nathen Bopp, Michelle M. Felicella, Bihong Zhao, Maximilian Buja, Jacklyn Nickels, Judith F. Aronson

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article number107558
JournalCardiovascular Pathology
Volume66
DOIs
StatePublished - Sep 1 2023

Keywords

  • Autopsy
  • COVID-19
  • Coronary Artery
  • Heart
  • SARS-CoV-2

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Cardiology and Cardiovascular Medicine

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