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Unexpected outcome (positive or negative) including adverse drug reactions
CASE REPORT
Necrotising coronaritis with fatal outcome
  1. Lisa Schweizer1,
  2. Nadja Fischer2,
  3. Thomas Fehr1,
  4. Stephan Schneiter1,3
  1. 1Department of Internal Medicine, Kantonsspital Graubunden, Chur, Switzerland
  2. 2Institute for Pathology, Kantonsspital Graubunden, Chur, Switzerland
  3. 3Division of Cardiology, Kantonsspital Graubunden, Chur, Switzerland
  1. Correspondence to Professor Thomas Fehr, Thomas.fehr{at}ksgr.ch

Summary

A 56-year-old woman presented with acute onset of typical chest pain. She was diagnosed with acute coronary syndrome with ST-segment elevation myocardial infarction. Although significant obstructive coronary artery disease was ruled out by coronary angiography, cardiac MRI showed transmural necrosis of the lateral free wall with extensive microvascular obstruction consistent with ischaemic heart disease. Within 48 hours after initial presentation, the patient suddenly arrested due to pulseless electrical activity with futile resuscitation efforts. Autopsy revealed myocardial perforation with extensive haematothorax due to pericardial laceration, caused by the mechanical chest compressions. Eventually, histology identified diffuse necrotising coronary vasculitis as a rare cause of ischaemic heart disease.

  • Ischaemic Heart Disease
  • Interventional Cardiology
  • Pathology
  • Vasculitis

https://doi.org/10.1136/bcr-2017-219489

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    Footnotes

    • Contributors TF had the idea for the article, managed the case and is the guarantor for the article. NF submitted the pictures from the pathology and wrote the pathological findings. LS and SS performed the literature search and wrote the article. LS was responsible for the data collection. SS wrote the cardiological findings.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.