title: A case of sudden cardiac death due to eosinophilic coronary periarteritis: possible significance of coexisting atherosclerosis and eosinophilic inflammation of the esophagus.
abstract: BACKGROUND
  Eosinophilic coronary periarteritis (ECPA) is a rare disease found in cases of sudden cardiac death due to coronary vasospasm or spontaneous coronary artery dissection. Currently, the etiology, pathogenesis, and pathophysiology of ECPA are unknown. Cases of ECPA with a history of allergic disorders are rare. Only one case of ECPA with tissue eosinophilia in another organ has been reported.
  
  
  METHODS
  A 50-year-old male suddenly died after complaining of chest pain. An autopsy with histopathologic analysis was performed.
  
  
  RESULTS
  A short segment of the left anterior descending artery had ECPA with dense eosinophilic inflammation of the adventitia and mild atherosclerosis. There were findings atypical of ECPA including mild focal eosinophilic infiltration of the intima and media associated with proliferation of vasa vasorum, fragmented internal and external elastic laminae, and fibrosis of the media. In addition, eosinophilic inflammation of the esophagus without mucosal involvement was present. The eosinophilic inflammation of the coronary artery and esophagus was accompanied by an increased number of mast cells.
  
  
  CONCLUSIONS
  This case suggests that ECPA and atherosclerosis may act synergistically by induction of inflammation and vasa vasorum neovascularization. Vasa vasorum and mast cell infiltration may trigger vasospasm and spontaneous coronary artery dissection. Although concurrent tissue eosinophilia elsewhere is rarely observed in cases of ECPA, collective analysis of these cases may elucidate the etiology and pathophysiology of ECPA.
authors.affiliation: Department of the Medical Examiner, City and County of Honolulu, 835 Iwilei Rd, Honolulu, HI 96817, USA; Department of Pathology, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI 96813, USA. Electronic address: mkobayashi@honolulu.gov.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Pathology and Laboratory Medicine, Spectrum Health Blodgett Campus, 1840 Wealthy St SE, Grand Rapids, MI 49506, USA. Electronic address: sdcohle@comcast.net.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cohle
mesh_terms: D001167:Arteritis / Q000150:complications* / Q000473:pathology; D001344:Autopsy; D003324:Coronary Artery Disease / Q000150:complications* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000473:pathology; D004802:Eosinophilia / Q000150:complications* / Q000473:pathology; D057765:Eosinophilic Esophagitis / Q000150:complications* / Q000473:pathology; D004804:Eosinophils / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008407:Mast Cells / Q000473:pathology; D008875:Middle Aged; D009389:Neovascularization, Pathologic
keywords: Atherosclerosis; Coronary artery dissection; Eosinophilic coronary periarteritis; Mast cells; Vasa vasorum; Vasospasm