A team of pathologists from Louisiana State University have published what is believed to be the first case report on pathologic findings of vasculitis of the small vessels of the heart, which likely represents multisystem inflammatory syndrome (MIS).1
The LSU Health New Orleans pathologists identified microscopic evidence of inflammation involving the small cardiac vessels during the autopsy of a patient who died weeks after initially recovering from Covid-19. MIS is a severe illness featuring severe inflammation of multiple organs that occurs after the resolution of covid symptoms. Similar to Kawasaki disease, MIS cases have been increasingly reported among children and young adults. Although vascular damage seems to be a component of both diseases, the pathologic features of MIS have not yet been described.
“We also found new pulmonary blood clots in a background of otherwise reparative changes in the lungs,” notes Sharon Fox, MD, PhD, associate director of Research and Development in the Department of Pathology at LSU Health New Orleans School of Medicine. “These clots indicate a potential for increased clotting affecting the pulmonary blood vessels beyond the initial course of COVID-19, as well as the need for continued monitoring of laboratory markers and possible anticoagulation.”
“Our report highlights the potential for serious complications due to damage to the lining of the vessels in the heart after COVID-19,” adds Richard Vander Heide, MD, PhD, professor and director of Pathology Research at LSU Health New Orleans School of Medicine.
The team concludes, “Careful monitoring of laboratory markers of cardiac and systemic inflammation, as well as therapeutic intervention to target this inflammatory process, may improve patient outcomes.”
1. Fox SE, Lameira FS, Rinker EB, Vander Heide RS. Cardiac endotheliitis and multisystem inflammatory syndrome after covid-19. Ann Intern Med. Epub July 29, 2020. doi: 10.7326/L20-0882.
Featured image: Pathologic characteristics of cardiac endotheliitis and multisystem vasculitis. A. Intact cardiac myocytes with a pattern of endotheliitis and vasculitis involving intervening small blood vessels and interstitial spaces, seen throughout extensive sampling of the heart (hematoxylin–eosin stain). B. Low-power image of a cardiac blood vessel with inflammatory cuffing (blue arrow) and no evidence of direct myocardial involvement. Courtesy, Louisiana State University.