Acute occlusive large vessel disease leading to fatal stroke in a patient with systemic lupus erythematosus: Arteritis or atherosclerosis?

Abstract

A woman with a history of systemic lupus erythematosus presented with extensive bilateral strokes due to acute inflammatory, occlusive large vessel disease affecting several aortic branches including the carotid, subclavian, renal, and iliac arteries. We quantitatively characterized the arterial inflammation in this patient and compared it with the inflammatory infiltrates from 22 patients with conventional atherosclerosis. Profound histomorphologic differences from conventional atherosclerosis (predominance of CD8-positive lymphocytes, relative absence of macrophages, no ectopic neovascularization, no signs of plaque hemorrhage, concentric instead of eccentrical stenosis) suggest that this patient's accelerated arteriopathy was precipitated by pathogenic events other than conventional atherosclerosis.

Massive vasculitic cerebellar infarction in patient with systemic lupus erythematosus

“…[3][4][5] However, our patient presented massive cerebellar infarction without any previously supposed mechanisms. [7] However, our patient differed from those patients because she presented with life-threatening cerebellar infarction and vasculitic pathology in a single region. Pathology of the lesion also showed features of vasculitis.…”

“…[3] The common causes of cerebral infarction in patients with SLE include cardio-embolism, hypercoagulable states and atherosclerosis. [6,7] These reports describe bilateral multiple cerebral infarcts with necrotizing vasculitis [6] or extensive bilateral cerebral infarction with acute occlusive large-vessel disease. She had serological markers of highly active SLE, high titers of anti-dsDNA and low complement level.…”

CD8+ T cell activation predominate early immune responses to hypercholesterolemia in Apoe-/- mice

“…Targeting of a CD8 + T cell immune response against arterial smooth muscle cells has been shown to markedly aggravate atherosclerosis in Apoe -/- mice [35]. CD8 + T cells have also been implicated in the accelerated atherosclerosis that occurs in patients with autoimmune diseases such as systemic lupus erythematosus [36]. In a study by Elhage and coworkers [37] CD8 deficiency did not influence atherosclerosis development in Apoe -/- mice.…”

An extended high‐frequency ultrasound protocol for detection of vessel wall inflammation

“…It has been reported that atrial myxoma with metastasis causing inflammation in the vessel wall could be misdiagnosed as Takayasu arteritis (Tan et al, 2010;Fung et al, 2014). Most pathologic lesions in SLE are not caused by vasculitis, but acute occlusion of large arteries due to arteritis (Conen et al, 2006) and focal sites of arteritis affecting the coronary arteries or aorta have been described. Svenungsson et al showed that patients with SLE had increased IMT compared to SLE controls in a study of 26 patients (Svenungsson et al, 2001).…”