Infective coronary arteritis: A pathological analysis at autopsy

Coronary artery disease, one of the leading causes of worldwide adult mortality, is most commonly atherosclerotic in pathogenesis. Nonatherosclerotic etiologies are quite rare. In the latter category, infective arteritis or infective vasculitis of the coronary arteries is a very rare but well-recognized subtype, usually discovered at autopsy. In this article, we present the clinicopathologic necropsy data of 10 patients in whom infective coronary arteritis was the leading cause of death. Among the 10 cases, the male/female ratio was 6:4, and with the exception of a 2-year-old female child, all the other patients were adults with an age range of 26 to 59 years. Of the 10 cases, 6 had infective endocarditis along with history of rheumatic heart disease in 3 patients, whereas 2 other patients had strong clinical suspicion of bacteremia or septicemia. The remaining 2 cases had preexisting coronary atherosclerosis with a history of stent placement in 1 of them. All our cases showed on histopathology acute obliterative inflammatory infiltrate consisting mainly of neutrophils along with bacterial colonies (in most of them) involving the epicardial and intramural coronary arteries. To the best of our knowledge, this is the largest series of infective coronary arteritis to be reported in the world.