Multiple coronary aneurysms resulting from isolated coronary vasculitis in an elderly patient

An 81-year-old man developed multiple coronary aneurysms, including the left main truncus, that were unexpectedly found by coronary angiography. He had been followed-up for 14 years because of angina pectoris; his initial coronary angiograms in 1985 showed some stenotic segments but no aneurysmal changes. The patient died of gastric cancer in March 2000. On microscopic examination of the coronary arteries, the prominent feature was an inflammatory reaction in the medial layer, comprising chiefly small lymphocytes and plasma cells. The internal and the external elastic membranes were destroyed, presumably causing the aneurysmal dilatation of the vessels. There was a moderate degree of concomitant atherosclerotic fibrointimal thickening. No evidence of vasculitis was seen in sections of the aorta, peripheral arteries, and other major organs. The present case is unique because the cellular infiltrates were confined to the coronary media and although a definite diagnosis was not made, it was probably an atypical form of vasculitic disease; namely, isolated coronary vasculitis.