Sudden death due to Takayasu arteritis complication associated with situs inversus totalis: A case discovered at autopsy

• Published in: Journal of forensic and legal medicine Vol. 96; p. 102527
• Main Authors: Ben Jomaa, Sami, El Aini, Imen, Chebbi, Elaa, Ben Hammouda, Seifeddine, Bouzid, Oumeima, Haj Salem, Nidhal
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-05-2023
• Subjects: Adult; Aorta - pathology; Aortic valve; Autopsy; Death, Sudden - etiology; Female; Humans; Insufficiency; Situs inversus; Situs Inversus - complications; Situs Inversus - pathology; Sudden death; Takayasu arteritis; Takayasu Arteritis - complications; Takayasu Arteritis - diagnosis; Takayasu Arteritis - pathology; Autopsy; Sudden death; Insufficiency; Situs inversus; Takayasu arteritis; Aortic valve; TAK
• ISSN: 1752-928X; 1878-7487
• DOI: 10.1016/j.jflm.2023.102527

Takayasu arteritis is a rare pathology that usually has general and atypical signs that make its diagnosis difficult. These characteristics can delay diagnosis, thus leading to complications and death. We, herein, report an autopsy case of a 25-year-old female patient with a history of multiple consultations for dyspnea. During these consultations, no diagnosis was made. She was found unconscious near her home and shortly after, she was declared dead. Forensic autopsy revealed superficial traumatic lesions. Internal examination revealed complete situs inversus. Multiple bilateral pleural adhesions and bilateral moderate effusion were found. The heart was heavy with thickening of the aortic wall (1.1cm), carotid arteries, and pulmonary trunk, associated with a large aortic valve and evidence of leakage. Histological examination of the aorta and its major branches showed features of panarteritis with segmental involvement. The vascular wall was thick with lymphoplasmacytic infiltrate and giant cells involving mainly the medio-adventitial junction. Disruption of the elastic lamina and reactive fibrosis in the intima were also noted. Diagnosis of large vessel vasculitis and particularly Takayasu arteritis was made.
Death was therefore attributed to heart failure due to aortic insufficiency as a complication of Takayasu arteritis.
•Takayasu Arteritis is a rare disease that can lead to death.•Sudden death can be the only clinical manifestation of Takayasu Arteritis.•First-line doctor must take into consideration these types of complications.