An autopsy case of myocardial infarction due to idiopathic thrombotic thrombocytopenic purpura

Diagnostic Pathology

Toshiyuki Nakayama¹  Yasuyuki Sasaguri²  Masanori Hisaoka³  Aya Nawata¹  Hirotsugu Noguchi¹  Atsunori Nabeshima¹  Sohsuke Yamada¹  Takashi Tasaki¹ 

[1] Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan;Department of Pathology, Fukuoka Wajiro Hospital, Fukuoka, Japan;Pathology and Oncology, University of Occupational and Environmental Health, Kitakyusyu, Japan

关键词: Arrhythmia;    Thrombotic thrombocytopenic purpura;    Myocardial infarction;    Heart conduction system;    Autopsy;    Pathology;   

Others  :  1217775
DOI  :  10.1186/s13000-015-0285-1

 received in 2015-01-13, accepted in 2015-04-22,  发布年份 2015

【 摘 要 】

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder characterized by systemic platelet-von Willebrand factor aggregation, organ ischemia and profound thrombocytopenia. In this report, we describe an autopsy case of a 77-year-old Japanese man diagnosed with idiopathic TTP. He had no history of cardiovascular disease symptoms, such as chest pain, ST segment elevation, and elevation of cardiac enzyme levels, except arrhythmia. The patient suddenly died despite receiving many treatments. On autopsy, macroscopically and microscopically, acute and chronic myocardial infarction manifested as petechiae and fibrotic foci and covered a wide area in the myocardium, including the area near the atrioventricular node. The microthrombi in the small arterioles and capillaries were platelet thrombi, which showed positive results for periodic acid-Schiff stain and factor VIII on immunohistochemical staining. The cause of the sudden death was suspected to be myocardial infarction, including a cardiac conduction system disorder due to multiple platelet microthrombi. Asymptomatic myocardial infarction is an important cause of death in TTP. Therefore, the heart tissue, including the sinus-atrial node and the atrioventricular node, should be microscopically examined more closely in autopsy cases of patients with TTP who experienced sudden death of TTP. This report is a critical teaching case considering that its cause of sudden death may be arrhythmia due to a myocardial infarction including cardiac conduction system disorder by platelet microthrombi.

【 授权许可】

   
2015 Tasaki et al.; licensee BioMed Central.

【 图 表 】

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