case_images: PMC10833439_01
case_images: Right coronary artery (gross and microscopic examination). A. Gross finding showing critical lumen compression. B-C. Diffuse lymphocytic infiltrates involving predominantly the media, with areas of adventitial and intimal involvement, with multiple foci of disrupted elastic lamina, marked lumen stenosis, and intimal atherosclerotic plaque (B - H&E 40X; C - H&E 100X). D. Masson trichrome stain: patchy areas of fibrosis within the coronary artery wall. E. Verhoeff elastin: areas of disrupted adventitial elastic lamina.
case_images: cureus-0016-00000051531-i01.jpg
case_images: PMC10833439_01_cureus-0016-00000051531-i01.jpg
case_images: FIG1
case_images: Examination of the heart revealed a pinpoint right coronary artery lumen without clear evidence of intraluminal thrombus or atherosclerotic deposits (Figure 1A). Microscopic examination of the right coronary artery (Figures 1B-1E) demonstrated diffuse lymphocytic infiltrates in the arterial wall predominantly involving the media, with areas of adventitial and intimal involvement, with marked lumen stenosis and multiple foci of disrupted elastic lamina.
case_images: Heart histology. Diffuse myocardial vacuolization (H&E, 100X)
case_images: cureus-0016-00000051531-i02.jpg
case_images: PMC10833439_01_cureus-0016-00000051531-i02.jpg
case_images: FIG2
case_images: Sections of the myocardium showed findings consistent with acute and subacute myocardial ischemia, including vacuolation of cardiomyocytes (Figure 2), foci of intraparenchymal hemorrhage and coagulative necrosis, granulation tissue, and lymphocytic infiltrates within the posterior wall of the left ventricle, interventricular septum, and right ventricle.