Sudden Death Due to Coronary Arteritis

Abstract

We report the case of a middle-aged man, without medical history, who suddenly died at his workplace. The autopsy highlighted a pathological heart macroscopically, with multiple small white areas on the left myocardium. Coronary dissection revealed a pseudotumoural fibromyxoid aspect within the anterior interventricular artery (AIVA) and the left main coronary trunk, including reduction in their diameter with tight stenosis. Microscopic examination of these arteries showed fibroinflammatory wall destruction. In the left myocardium, there were multiple focal ischemic areas at different stages of recovery. Our case is an illustration of primary ischemic heart disease due to coronary arteritis, with a pseudotumoural presentation, which was revealed by sudden death. We discuss the cause of death and the etiological diagnosis preceding coronary arteritis.

Authors’ Response

“…Akiyama (1) reported that no tissue staining for IgG4 and IgG was conducted in our isolated coronary arteritis case report (2). IGg4‐related disease (IgG4RD) is a systemic disorder associating increase of serum IgG4 level, tissue infiltration of IgG4 positive plasma cells and fibrosis or sclerosis (3).…”

Commentary on: Gabarrou G, Guilbeau‐Frugier C, Blanc A, Telmon N, Savall F. Necessity for recognition of IgG4‐related coronary arteritis and elucidating treatment strategy. J Forensic Sci 2018;63(2):611–3. https://doi.org/10.1111/1556‐4029.13561.

“…Gabarrou et al (6) reported the case of a middle‐aged man with isolated coronary arteritis with unknown etiology. Their case presented with sudden cardiac death and the autopsy revealed the pseudotumoural macroscopic aspect of the anterior intraventricular artery with severe stenosis (>90%), indicating the diffuse wall thickening and stenotic type.…”