title: Myocytolysis as a result of vascular rejection: biopsy and autopsy findings--a case report.
abstract: Vascular pathologic lesions are a severe and irreversible complication of allogeneic heart transplantation despite immunoprophylactic treatment. These vascular alterations may be characterized by a lymphocytic vasculitis or lumen occlusion by proliferative vasculopathy (or both). They are not readily detected by endomyocardial biopsy. We describe a patient who expired 21 weeks after orthotopic heart transplantation. Graft failure was caused by extensive vascular changes of both an infiltrative and a proliferative nature with subsequent ischemic damage to the myocardium. Vacuolated myocytes observed in the last biopsy specimen obtained before death appeared at postmortem investigation to represent a subendocardial strip of sublethally injured myocytes. Because ischemic damage as a result of vascular rejection may involve a much larger area of the myocardium than the diseased vessel itself, subendocardial myocytic vacuolation in the biopsy specimen may be a valuable diagnostic sign indicating vasculopathy in the graft.
authors.affiliation: Department of Internal Medicine, University Hospital, Utrecht, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: Slootweg
authors.forename: H J
authors.initials: HJ
authors.lastname: Schuurman
authors.forename: G
authors.initials: G
authors.lastname: Jambroes
mesh_terms: D000328:Adult; D004699:Endocardium / Q000473:pathology; D004719:Endomyocardial Fibrosis / Q000473:pathology; D006084:Graft Rejection; D016027:Heart Transplantation / Q000473:pathology*; D006801:Humans; D008297:Male; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D014617:Vacuoles / Q000473:pathology; D014657:Vasculitis / Q000473:pathology