From the Johnson County Medical Examiner's Office, Olathe, KS.
Am J Forensic Med Pathol. 2022 Mar 1;43(1):52-54. doi: 10.1097/PAF.0000000000000737.
Spontaneous multiple arterial dissection (SMAD) is a rarely reported phenomenon and has been previously linked to connective tissue diseases and specifically the genetic mutations in SMAD3 and COL3A1. Herein we describe a case of SMAD with scattered thrombi in a COVID-19-positive patient with a history of unspecified mitochondrial myopathy. Vasculopathy involved the splenic artery, inferior mesenteric artery, internal mammary arteries, omental arteries, mesenteric arteries, and small renal arteries. Dissections were confirmed by histology in the splenic artery, inferior mesenteric artery, and bilateral renal medullary arteries. Genetic studies were done to rule out SMAD3 and COL3A1 mutations. Because the Smad3 protein has been previously implicated in COVID-19-associated tissue fibrosis, it may play a role in endothelial dysfunction as well.
自发性多发性动脉夹层（SMAD）是一种罕见的现象，以前与结缔组织疾病有关，特别是 SMAD3 和 COL3A1 的基因突变。在此，我们描述了一例 COVID-19 阳性患者出现 SMAD 合并散在血栓形成的病例，该患者有未明确的线粒体肌病病史。血管病变累及脾动脉、肠系膜下动脉、内乳动脉、网膜动脉、肠系膜动脉和小肾动脉。脾动脉、肠系膜下动脉和双侧肾髓质动脉的组织学检查证实存在夹层。进行了基因研究以排除 SMAD3 和 COL3A1 突变。由于 Smad3 蛋白以前与 COVID-19 相关的组织纤维化有关，因此它也可能在血管内皮功能障碍中发挥作用。
