Severe lymphocytic endothelialitis associated with coronary artery spasm in a heart transplant recipient

Coronary artery spasm plays an important role in ischemic heart disease, particularly variant angina. We report the case of a 59-year-old man who developed severe diffuse coronary artery spasm 11 months after he received a heart transplant. The spasm was reversed by a single dose of sublingual nitroglycerin; however, the patient died 9 days later of Pneumocystis carinii pneumonia. Postmortem examination of this patient's heart revealed accelerated arteriosclerosis, with a prominent diffuse lymphocytic endothelialitis in the coronary arteries. The lymphocytic endothelialitis was characterized by the presence of numerous T lymphocytes and macrophages in the subendothelial space and by histologic changes suggesting injury to the endothelial cells. Although an association does not prove a causal relationship, the findings of accelerated arteriosclerosis and lymphocytic endothelialitis in a patient with coronary artery spasm suggests that these processes may be etiologically linked.