Abstract 14038: Multiple Infective Coronary Arteritis Complicated with Bacterial Pericarditis
A 69 year old male was referred to our institute because of dyspnea, chest compression, and fever (39.1oC). He had had Sjögren’s syndrome, diabetes mellitus, and hypertension and had been taking a low dose of steroid orally for Sjögren’s syndrome. Serum white blood cell count and C-reactive protein were 22100/μL and 37.7mg/dl respectively. Transthoracic echocardiography revealed massive pericardial effusion and on pericardiocentesis, 200ml of purulent pericardial effusion was obtained. Pneumococcus was detected from blood culture and intravenous injection of antibiotics was started. Open-heart surgery was performed with maintenance of pericardial effusion and 300ml of purulent pericardial effusion was extracted. Inflammatory cells including neutrophils and lymphocytes were observed in the extract. On transesophageal echocardiography, presence of an abscess around the left coronary cusp was suspected and cardiac CT was performed. On CT, pericardial effusion and aneurysm with thickened wall, but without luminal stenosis in right coronary artery (RCA), aneurysm with thickened wall in left main (LM) trunk; and luminal stenosis with thickened wall in left anterior descending artery (LAD) were observed. From those findings, presence of coronary arteritis complicated with pericarditis was suspected. The patient had bloody bowel diarrhea, and colonoscopy revealed presence of colon cancer. As infection was not controlled, he died 31 days after admission. Subsequent autopsy showed macro-level findings of aneurysm with thickened wall complicated with hemorrhage in RCA and with thrombus in LM trunk. Thickened and hardened epicardium was also observed, which was in accordance with the clinical diagnosis of pericarditis. On hematoxylin and eosin staining, remarkable fibrous thickening of the intima and inflammatory cell invasion into vessel wall, mainly media, was observed. The epicardium was thickened and inflamed with fibrinous deposition.
Author Disclosures: N. Funabashi: None. H. Takaoka: None. H. Takano: None. T. Kishimoto: None. M. Sano: None. T. Yamaoka: None. K. Ozawa: None. Y. Kobayashi: None.
- © 2014 by American Heart Association, Inc.