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Spontaneous Multiple Arterial Dissection in a COVID-19-Positive Decedent.

Christine James¹, Diane C Peterson

¹From the Johnson County Medical Examiner's Office, Olathe, KS.

The American Journal of Forensic Medicine and Pathology

|December 23, 2021

Summary

Spontaneous multiple arterial dissection (SMAD) is rare, often linked to genetic factors. This case highlights SMAD in a COVID-19 patient with mitochondrial myopathy, suggesting potential roles for Smad3 in viral-induced endothelial dysfunction.

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Area of Science:

Vascular Biology
Infectious Diseases
Genetics

Background:

Spontaneous multiple arterial dissection (SMAD) is a rare vascular condition, typically associated with connective tissue disorders and specific gene mutations (SMAD3, COL3A1).
Understanding the etiology of SMAD is crucial for diagnosis and management, especially in atypical presentations.

Observation:

A case of SMAD involving multiple arteries (splenic, mesenteric, renal, etc.) is presented in a patient who was positive for COVID-19.
The patient had a history of unspecified mitochondrial myopathy, adding complexity to the clinical picture.
Histological confirmation of arterial dissections was obtained for several affected vessels.

Findings:

Genetic testing ruled out mutations in SMAD3 and COL3A1, suggesting alternative underlying mechanisms for SMAD in this patient.
The presence of scattered thrombi within the dissected arteries was noted.
The patient's COVID-19 positivity is a significant factor in this presentation.

Implications:

The findings suggest a potential link between COVID-19 infection and the development of SMAD, possibly through endothelial dysfunction.
The role of the Smad3 protein, previously implicated in COVID-19-associated fibrosis, is explored in the context of endothelial dysfunction and vasculopathy.
This case broadens the spectrum of potential causes for SMAD and underscores the need for considering infectious triggers.