A clinicopathological analysis of six autopsy cases of sudden unexpected death due to infectious aortitis in patients with aortic tears

Marin Ishikawa, Mishie Ann Tanino, Masaya Miyazaki, Taichi Kimura, Yusuke Ishida, Lei Wang, Masumi Tsuda, Hiroshi Nishihara, Kazuo Nagashima, Shinya Tanaka

Research output: Contribution to journalArticle

Abstract

Objective Cardiovascular disease is a leading cause of sudden unexpected death even in hospitalized patients. Infectious aortitis is a rare disease that has the potential to cause aortic tears and hemorrhage followed by sudden death. The aim of this study was to reveal the clinicopathological features of infectious aortitis that are related to sudden unexpected death. Methods We retrospectively reviewed 1,310 autopsy cases over 15 years and selected the cases involving patients who died suddenly due to aortic tears. We analyzed the clinical information and pathological findings. Results One hundred thirty-three of 1,310 cases (10.2%) were autopsied under the clinical diagnosis of unexpected sudden death. Aortic tears were identified in 33 cases (2.5%) and infectious aortitis was diagnosed in 6 (18.2%) of these cases. All cases involved male patients (middle-aged to elderly) with risk factors for atherosclerosis (i.e., hypertension). The laboratory data showed continuous leukocytosis and C-reactive protein elevation, even during the improvement phase, in patients with pre-existing infectious disease. The autopsy findings revealed three types of aortic tears (aneurysms, dissections and penetrating atherosclerotic ulcers with moderate to severe atherosclerosis), and the infiltration of numerous neutrophils at the site of rupture. Gram-positive bacteria were detected in four cases and Gram-negative bacteria were detected in two cases. Discussion We demonstrated that sudden unexpected death caused by infectious aortitis rarely occurred in hospitalized patients, even in the recovery phase of the preceding infectious disease. We therefore recommend that clinicians pay attention to infectious aortitis in patients with infectious disease, particularly elderly patients with atherosclerotic disease, even those who are in the improvement phase. Conclusion Unexpected sudden death by infectious aortitis in the recovery phase of antecedent infection.

Original languageEnglish
Pages (from-to)1375-1380
Number of pages6
JournalInternal Medicine
Volume57
Issue number10
DOIs
Publication statusPublished - 2018 Jan 1
Externally publishedYes

Fingerprint

Aortitis
Sudden Death
Tears
Autopsy
Communicable Diseases
Atherosclerosis
Preexisting Condition Coverage
Neutrophil Infiltration
Aortic Aneurysm
Leukocytosis
Gram-Positive Bacteria
Rare Diseases
Gram-Negative Bacteria
C-Reactive Protein
Ulcer
Dissection
Rupture
Cardiovascular Diseases
Hemorrhage
Hypertension

Keywords

  • Aortic aneurysm
  • Aortic dissection
  • Atherosclerosis
  • Infectious aortitis
  • Penetrating atherosclerotic ulcer
  • Sudden death

ASJC Scopus subject areas

  • Internal Medicine

Cite this

A clinicopathological analysis of six autopsy cases of sudden unexpected death due to infectious aortitis in patients with aortic tears. / Ishikawa, Marin; Tanino, Mishie Ann; Miyazaki, Masaya; Kimura, Taichi; Ishida, Yusuke; Wang, Lei; Tsuda, Masumi; Nishihara, Hiroshi; Nagashima, Kazuo; Tanaka, Shinya.

In: Internal Medicine, Vol. 57, No. 10, 01.01.2018, p. 1375-1380.

Research output: Contribution to journalArticle

Ishikawa, M, Tanino, MA, Miyazaki, M, Kimura, T, Ishida, Y, Wang, L, Tsuda, M, Nishihara, H, Nagashima, K & Tanaka, S 2018, 'A clinicopathological analysis of six autopsy cases of sudden unexpected death due to infectious aortitis in patients with aortic tears', Internal Medicine, vol. 57, no. 10, pp. 1375-1380. https://doi.org/10.2169/internalmedicine.8976-17
Ishikawa, Marin ; Tanino, Mishie Ann ; Miyazaki, Masaya ; Kimura, Taichi ; Ishida, Yusuke ; Wang, Lei ; Tsuda, Masumi ; Nishihara, Hiroshi ; Nagashima, Kazuo ; Tanaka, Shinya. / A clinicopathological analysis of six autopsy cases of sudden unexpected death due to infectious aortitis in patients with aortic tears. In: Internal Medicine. 2018 ; Vol. 57, No. 10. pp. 1375-1380.
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AU - Ishikawa, Marin

AU - Tanino, Mishie Ann

AU - Miyazaki, Masaya

AU - Kimura, Taichi

AU - Ishida, Yusuke

AU - Wang, Lei

AU - Tsuda, Masumi

AU - Nishihara, Hiroshi

AU - Nagashima, Kazuo

AU - Tanaka, Shinya

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N2 - Objective Cardiovascular disease is a leading cause of sudden unexpected death even in hospitalized patients. Infectious aortitis is a rare disease that has the potential to cause aortic tears and hemorrhage followed by sudden death. The aim of this study was to reveal the clinicopathological features of infectious aortitis that are related to sudden unexpected death. Methods We retrospectively reviewed 1,310 autopsy cases over 15 years and selected the cases involving patients who died suddenly due to aortic tears. We analyzed the clinical information and pathological findings. Results One hundred thirty-three of 1,310 cases (10.2%) were autopsied under the clinical diagnosis of unexpected sudden death. Aortic tears were identified in 33 cases (2.5%) and infectious aortitis was diagnosed in 6 (18.2%) of these cases. All cases involved male patients (middle-aged to elderly) with risk factors for atherosclerosis (i.e., hypertension). The laboratory data showed continuous leukocytosis and C-reactive protein elevation, even during the improvement phase, in patients with pre-existing infectious disease. The autopsy findings revealed three types of aortic tears (aneurysms, dissections and penetrating atherosclerotic ulcers with moderate to severe atherosclerosis), and the infiltration of numerous neutrophils at the site of rupture. Gram-positive bacteria were detected in four cases and Gram-negative bacteria were detected in two cases. Discussion We demonstrated that sudden unexpected death caused by infectious aortitis rarely occurred in hospitalized patients, even in the recovery phase of the preceding infectious disease. We therefore recommend that clinicians pay attention to infectious aortitis in patients with infectious disease, particularly elderly patients with atherosclerotic disease, even those who are in the improvement phase. Conclusion Unexpected sudden death by infectious aortitis in the recovery phase of antecedent infection.

AB - Objective Cardiovascular disease is a leading cause of sudden unexpected death even in hospitalized patients. Infectious aortitis is a rare disease that has the potential to cause aortic tears and hemorrhage followed by sudden death. The aim of this study was to reveal the clinicopathological features of infectious aortitis that are related to sudden unexpected death. Methods We retrospectively reviewed 1,310 autopsy cases over 15 years and selected the cases involving patients who died suddenly due to aortic tears. We analyzed the clinical information and pathological findings. Results One hundred thirty-three of 1,310 cases (10.2%) were autopsied under the clinical diagnosis of unexpected sudden death. Aortic tears were identified in 33 cases (2.5%) and infectious aortitis was diagnosed in 6 (18.2%) of these cases. All cases involved male patients (middle-aged to elderly) with risk factors for atherosclerosis (i.e., hypertension). The laboratory data showed continuous leukocytosis and C-reactive protein elevation, even during the improvement phase, in patients with pre-existing infectious disease. The autopsy findings revealed three types of aortic tears (aneurysms, dissections and penetrating atherosclerotic ulcers with moderate to severe atherosclerosis), and the infiltration of numerous neutrophils at the site of rupture. Gram-positive bacteria were detected in four cases and Gram-negative bacteria were detected in two cases. Discussion We demonstrated that sudden unexpected death caused by infectious aortitis rarely occurred in hospitalized patients, even in the recovery phase of the preceding infectious disease. We therefore recommend that clinicians pay attention to infectious aortitis in patients with infectious disease, particularly elderly patients with atherosclerotic disease, even those who are in the improvement phase. Conclusion Unexpected sudden death by infectious aortitis in the recovery phase of antecedent infection.

KW - Aortic aneurysm

KW - Aortic dissection

KW - Atherosclerosis

KW - Infectious aortitis

KW - Penetrating atherosclerotic ulcer

KW - Sudden death

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