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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
PubMed

Insights

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.

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.

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