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

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.