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Chinello P, Gavaruzzi F, Epifani AC, Taglietti F. Giant cell arteritis after COVID-19 vaccination/disease: suggestions for further shots? Vascular 2024; 32:476-478. [PMID: 36395736 PMCID: PMC9679323 DOI: 10.1177/17085381221140161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Pierangelo Chinello
- 2nd Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy
| | - Francesca Gavaruzzi
- 2nd Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy
| | - Anna Chiara Epifani
- 2nd Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy
| | - Fabrizio Taglietti
- 2nd Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy
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Boor PJ, Srinivasan M, Stevenson HL, Gong B, Nyong E, Dong J, Popov V, Sherman M, Bopp N, Felicella MM, Zhao B, Buja M, Nickels J, Aronson JF. Necrotizing plasma cell-rich aortitis and sudden cardiac death: Late sequelae of COVID-19? Cardiovasc Pathol 2023; 66:107558. [PMID: 37419163 DOI: 10.1016/j.carpath.2023.107558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023] Open
Abstract
The ongoing epidemic caused by the coronavirus SARS-CoV-2 is characterized by a variety of pathologic processes within the syndrome of COVID-19. Usually beginning as an upper respiratory infection with potential progression to a pneumonitis, many cases of COVID-19 that show minimal signs or symptoms initially may develop adverse systemic sequelae later, such as widespread thrombo-embolic phenomena, systemic inflammatory disorders (especially in children), or vasculitis. Here, we present a patient who suffered a sudden cardiac death following persistent SARS-CoV-2 viral positivity for four-and-one-half months after a mild clinical viral course. At routine autopsy, a remarkable plasma cell-rich necrotizing aortitis was uncovered. The aortic intima displayed diffuse, circumferential ongoing chronic intimal edema, inflammation, and neo-vascularization. The plasma cell-rich inflammatory process also involved the origin of the left main coronary artery (LM) causing a coronary arteritis accompanied by subacute, stenosing intimal vascular smooth muscle cell (VSMC) proliferation resulting in acute myocardial necrosis as a cause of death. A similar vasculitis and plaque were noted during the routine autopsy at the ostium of the celiac artery; vasculitis was not found systemically or in smaller caliber vessels. Through a variety of techniques including extensive histopathologic and immunohistochemical characterization, immunostaining localization of viral antigen, and transmission electron microscopy we present highly suggestive evidence that this unique necrotizing, plasma cell-rich aortitis is a rare sequela of COVID-19.
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Affiliation(s)
- Paul J Boor
- Department of Pathology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA.
| | - Mukund Srinivasan
- Department of Pathology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Heather L Stevenson
- Department of Pathology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Bin Gong
- Department of Pathology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Emmanuel Nyong
- Department of Pathology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Jianli Dong
- Department of Pathology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Vsevolod Popov
- Department of Pathology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Michael Sherman
- Department of Biochemistry and Molecular Biology, Sealy Center for Structural Biology and Molecular Biophysics, University of Texas Medical Branch, Galveston, Texas, USA
| | - Nathen Bopp
- Department of Pathology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Michelle M Felicella
- Department of Pathology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Bihong Zhao
- Departments of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Maximilian Buja
- Departments of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Jaclyn Nickels
- Department of Pathology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA.
| | - Judith F Aronson
- Department of Pathology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
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Becker RC. Evaluating chest pain in patients with post COVID conditions permission to think outside of the box. J Thromb Thrombolysis 2023; 55:592-603. [PMID: 37052772 PMCID: PMC10098243 DOI: 10.1007/s11239-023-02808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
Chest pain is among the most common symptoms of post-COVID-19 Conditions (PCC) that prompts medical attention. Because the SARS-CoV-2 virus has proclivity for many organs and organ systems in the chest, ranging from the heart, lungs, great vessels, lymphatics, and peripheral nerves, clinicians evaluating patients with chest pain must consider a broad differential diagnosis and take a comprehensive approach to management.
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Garnett CC, Poist A, Lazenby C, Nielson J, Perry R. Acute Aortic Injury and Bilateral Pulmonary Emboli in the Setting of COVID-19. Cureus 2023; 15:e38330. [PMID: 37261158 PMCID: PMC10228553 DOI: 10.7759/cureus.38330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/02/2023] Open
Abstract
In this report, we present the case of a 72-year-old female diagnosed with an aortic dissection variant and bilateral pulmonary emboli (PE) in the setting of Coronavirus Disease of 2019 (COVID-19) infection. The patient was transported from home to the emergency department (ED) via emergency medical services (EMS) with acute chest pain and dyspnea. After arriving at the ED, she was hypoxic on her baseline supplemental O2 requirement and tachycardic and tachypneic. Computed tomography (CT) angiogram of the chest showed evidence of possible thoracic aortic dissection and bilateral PE. The patient was ultimately transported to a tertiary center for operative aortic repair and bilateral embolectomy and, fortunately, survived the procedures. Interestingly, during operative repair of the aorta, no obvious dissection flap was noted, but rather evidence of a limited tear in the intimal layer of the aorta. This is an interesting case as acute aortic injuries in the setting of COVID-19 infection have not been as widely documented as PE in the setting of COVID and highlight the need for further research on the possible association between them.
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Affiliation(s)
| | - Austin Poist
- Emergency Medicine, Kettering Health Network, Dayton, USA
| | - Chase Lazenby
- Emergency Medicine, Kettering Health Network, Dayton, USA
| | | | - Rebecca Perry
- Emergency Medicine, Kettering Health Network, Dayton, USA
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Irilouzadian R, Salehi Omran H, Alirezaei T. Fatal association of COVID-19 and acute type A aortic dissection. Clin Case Rep 2022; 10:e05617. [PMID: 35356160 PMCID: PMC8939039 DOI: 10.1002/ccr3.5617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/27/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Type A aortic dissection is a catastrophic event that requires prompt diagnosis and intervention to save the patient. It seems that type A aortic dissection in COVID-19 patients has increased severity, and even with immediate diagnosis, it has a high mortality.
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Affiliation(s)
- Rana Irilouzadian
- Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | | | - Toktam Alirezaei
- Cardiology Department of Shohadaye‐Tajrish HospitalShahid Beheshti University of Medical SciencesTehranIran
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Ramon A, Greigert H, Ornetti P, Bonnotte B, Samson M. Mimickers of Large Vessel Giant Cell Arteritis. J Clin Med 2022; 11:jcm11030495. [PMID: 35159949 PMCID: PMC8837104 DOI: 10.3390/jcm11030495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 01/27/2023] Open
Abstract
Giant cell arteritis (GCA) is a large-vessel granulomatous vasculitis occurring in patients over 50-year-old. Diagnosis can be challenging because there is no specific biological test or other diagnoses to consider. Two main phenotypes of GCA are distinguished and can be associated. First, cranial GCA, whose diagnosis is usually confirmed by the evidence of a non-necrotizing granulomatous panarteritis on temporal artery biopsy. Second, large-vessel GCA, whose related symptoms are less specific (fever, asthenia, and weight loss) and for which other diagnoses must be implemented if there is neither cephalic GCA nor associated polymyalgia rheumatica (PMR) features chronic infection (tuberculosis, Coxiella burnetti), IgG4-related disease, Erdheim Chester disease, and other primary vasculitis (Behçet disease, relapsing polychondritis, or VEXAS syndrome). Herein, we propose a review of the main differential diagnoses to be considered regarding large vessel vasculitis.
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Affiliation(s)
- André Ramon
- Rheumatology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France;
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Correspondence:
| | - Hélène Greigert
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
- Vascular Medicine Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Paul Ornetti
- Rheumatology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France;
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, 21000 Dijon, France
- INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport, 21000 Dijon, France
| | - Bernard Bonnotte
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Maxime Samson
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
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