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.
Hruban
R H
RH
Department of Pathology, Johns Hopkins Hospital, Baltimore, Md. 21205.
Kasper
E K
EK
Gaudin
P B
PB
Baughman
K L
KL
Baumgartner
W A
WA
Reitz
B A
BA
Hutchins
G M
GM
D003324:Coronary Artery Disease / Q000209:etiology / Q000473:pathology; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D004562:Electrocardiography; D004730:Endothelium, Vascular / Q000473:pathology*; D016027:Heart Transplantation / Q000473:pathology*; D006801:Humans; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013601:T-Lymphocytes / Q000473:pathology