title: Severe lymphocytic endothelialitis associated with coronary artery spasm in a heart transplant recipient.
abstract: 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.
authors.affiliation: Department of Pathology, Johns Hopkins Hospital, Baltimore, Md. 21205.
authors.forename: R H
authors.initials: RH
authors.lastname: Hruban
authors.forename: E K
authors.initials: EK
authors.lastname: Kasper
authors.forename: P B
authors.initials: PB
authors.lastname: Gaudin
authors.forename: K L
authors.initials: KL
authors.lastname: Baughman
authors.forename: W A
authors.initials: WA
authors.lastname: Baumgartner
authors.forename: B A
authors.initials: BA
authors.lastname: Reitz
authors.forename: G M
authors.initials: GM
authors.lastname: Hutchins
mesh_terms: 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