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Necrotising coronaritis with fatal outcome

Lisa Schweizer1, Nadja Fischer2, Thomas Fehr1

  • 1Department of Internal Medicine, Kantonsspital Graubunden, Chur, Switzerland.

BMJ Case Reports
|July 1, 2017
PubMed

Insights

A rare case of diffuse necrotising coronary vasculitis caused a 56-year-old woman's fatal myocardial infarction and cardiac arrest. This vasculitis led to ischaemic heart disease, mimicking typical acute coronary syndrome.

Area of Science:

  • Cardiology
  • Pathology
  • Immunology

Background:

  • Acute coronary syndrome (ACS) with ST-segment elevation myocardial infarction (STEMI) is a common emergency.
  • Coronary angiography is standard for diagnosing obstructive coronary artery disease (CAD).
  • Cardiac MRI is valuable for assessing myocardial viability and damage.

Observation:

  • A 56-year-old woman presented with STEMI symptoms, but angiography excluded obstructive CAD.
  • Cardiac MRI revealed transmural necrosis and microvascular obstruction, suggesting ischaemic heart disease.
  • The patient experienced sudden cardiac arrest due to pulseless electrical activity within 48 hours.

Findings:

  • Autopsy identified myocardial perforation and pericardial laceration, attributed to chest compressions.
  • Histology revealed diffuse necrotising coronary vasculitis as the underlying cause of myocardial necrosis.
  • This rare vasculitis mimicked typical ischaemic heart disease presentation.

Implications:

  • Diffuse necrotising coronary vasculitis is a rare but critical differential diagnosis for ischaemic heart disease.
  • Early recognition of vasculitis may alter patient management and prognosis.
  • This case highlights the importance of comprehensive autopsy in unexplained cardiac events.

Keywords:
Interventional CardiologyIschaemic Heart DiseasePathologyVasculitis

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