Multiple infectious pseudoaneurysms: An autopsy case

• Multiple pseudoaneurysms in both the aorta and coronary arteries are described.
• One of the pseudoaneurysms ruptured into the pericardium.
• Direct arterial infection was suspected as the cause of multiple pseudoaneurysms.
• Long-term steroid therapy has influenced the development of the infection.
• Intravenous drug abuse might have affected the onset of the infection.

A 47-year-old Japanese woman died unexpectedly 11 days after admission due to acute cerebellar infarction. The patient had a history of Sjögren syndrome with long-term steroid therapy, hypertension, thalamic infarction and amphetamine psychosis. Multiple pseudoaneurysms in both the aorta and coronary artery were found at autopsy, and one located in the aortic root had ruptured into the pericardium resulting in sudden unexpected death. The detailed examination suggested that the pseudoaneurysms resulted from microbial infection to the arterial wall via the vasa vasorum. Immunosuppression induced by the long-term steroid therapy and abused drug injection could have influenced the formation of pseudoaneurysms.

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