ECP 2022 Abstract Book

Virchows Archiv (2022) 481 (Suppl 1):S1–S364 13 must be readily identified, for which the aetiology of the pericarditis invests itself of a greater significance in the prognosis. Methods: A 67-year-old male patient with non-dilated ethanolic cardiomyopathy and chronic kidney disease presented to the emergency department with intense abdominal pain and hypotension. The echocardiogram revealed a pericardial effusion of 3 cm extent with hemodynamic failure. A pericardiocentesis to drain the effusion was initiated, but the patient suffered a cardiorespiratory arrest and died. Results: During the post-mortem, while opening the pericardial cavity, we found a large quantity of blood and clots, totalling a volume of approximately 750 mL. We also observed an epicardium with abundant fibrinous adhesions, which warranted a fibrinous pericarditis diagnosis. In our case, several aetiologies were proposed and investigated, having favoured the uremic cause, in the context of the patient’s chronic kidney disease, now acutely worsened by the clinical picture. In fact, the patient presented with very high levels of creatinine (4,03 mg/dL, reference values between 0,72 – 1,25) and urea (260 mg/dL, reference values between 18,0 – 55,0), as well as an estimated glomerular filtration rate of 14 mL/min/m2. Conclusion: Fibrinous pericarditis is caused by several factors, and in patients with chronic kidney disease, the uremic aetiology has to be considered. The accumulation of metabolites in the blood leads to an inflammatory response in the pericardium and the platelet dysfunction can further complicate this with hemopericardium. A careful autopsy examination, showing a dry, granular heart surface, covered in fibrinous exsudate, is typical. Our case shows how the post-mortem and its correlation with clinical findings enables a precise etiological diagnosis. E-PS-01-011 The histological effects of colchicine in the setting of Behcet’s disease: an autopsy case report J. Pimentel*, E. Dutra, C. Pontinha *Centro Hospitalar Universitário de Lisboa Central (CHULC), Portugal Background & objectives: Colchicine is a drug with antimitotic effects used in the treatment of a variety of medical conditions such as Behcet’s disease. It has a narrow therapeutic window, and its toxicity can result in multiorgan failure and death. Methods: We present the case of a 64-year-old female with hyper- tension, depressive disorder and Behcet’s disease. She was medi- cated with 1mg of Colchicine daily. The patient presented to the emergency department with a three-day history of abdominal pain, diarrhoea and vomiting, which culminated in her death. Clinical autopsy was requested. Results: The autopsy revealed extensive ecchymoses in both arms, generalized atherosclerosis, and hardened white pleural plaques in the apex of both lungs, among other changes. There were no mucosal ulcers or macroscopic changes to the myocardium. Histo- logical analysis showed an early stage myocardial ischemic event with associated neutrophils, precirrhotic alcoholic steatohepati- tis, renal hypertensive changes and pulmonary “apical caps”. In addition, histopathological study of the oesophagus, vagina and bladder showed epithelial pseudostratification, loss of polarity and multiple “ring” (metaphase) mitosis in their mucosas. There were no specific changes attributed to Behcet’s disease. No toxicological analyses of colchicine levels in blood or urine were available and no samples were collected. Conclusion: This case highlights the striking histopathological manifestations of colchicine, which only occur at toxic levels. They can therefore serve as a surrogate for toxicological analysis in cases such as this with clinical symptoms of toxicity. Despite not being always present, these signs should be recognized by the pathologist with great care not to misdiagnose them as dysplastic or neoplastic alterations. E-PS-01-012 Unexpected cause of a blunt vertebral artery injury with a lethal outcome and contributing factors M. Životić*, I. Filipović, A. Vujčić, D. Mitrović, I. Končar, P. Mutavdžić, B. Barišić, M. Tubić, D. Dunđerović *Institute of Pathology, Faculty of Medicine, University of Bel- grade, Serbia Background & objectives: The majority of vertebral artery injuries are due to blunt trauma from motor vehicle crashes while other causes are less common. Closed injuries of vertebral arteries are induced by hyperextension coupled with lateral flexion or rotation of the head. Methods: 43-year-old woman complained of the neck pain and shortness of breath lasting three days. MSCT angiography revealed a bleeding from the right vertebral artery with hematoma involving the neck, the mediastinum and the right hemithorax. The patient denies the injury, but states that she had a dental intervention seven days before the first symptoms. Results: The patient was urgently referred for vascular surgical procedure, but the lethal outcome occurred during the surgery. An autopsy confirmed transection of right vertebral artery in the neck, 2 cm away from origin, with the formation of hematoma in the neck and mediastinum, and severe right haemothorax (3000 ml blood). Further detailed examination revealed that the woman was suffering from hypertension (hypertensive heart, kidney and brain diseases), induced by incidentally found pheochromocytoma of the right adrenal gland. Furthermore, an external examination revealed several soft subcutaneous nodules of upper and lower extremities which histologically corresponded to neurofibromas, altogether indicating possible inherited diseases such as NF1 or MEN2. Conclusion: Bleeding from the vertebral artery in the neck is extremely rare consequence of blunt injury, usually caused by neck hyperextension, but not frequently associated with common procedures such as dental interventions. Mild but prolonged neck hyperextension causes a vertebral artery compression at the entry into the vertebral column, producing a focal vessel injury with a higher possibility of dissection/transection in hypertensive patients. In this case, hypertension induced by pheochromocytoma was con- tributing factor to fatal vertebral artery bleeding. Funding: Ministry of Education, Science and Technological Development of Republic of Serbia (No OI 175047) E-PS-01-013 Amyloiosis: report autopsy in a patient with suspected sepsis D. Nunes*, Á.M. Freire, H.M.G. Leite, T.P. Brasil, C.G.L. da Silva, G.B.d.S. Ponte, J.C. Melo, F.S. Marcelino Silva *University of Fortaleza, Brazil Background & objectives: Amyloidosis is a syndrome characterized by a group of diseases which have in common extracellular protein deposits called amyloid fibrils. Methods: Autopsy report of a 53-year-old woman with abdominal discomfort, inappetence and asthenia, evolving with progressive worsening and severe hepatic and renal dysfunction requiring dialysis, deep vein thrombosis and suspected sepsis. Results: At autopsy, yellowish meninges; congested brain; volumi- nous bilateral pleural effusion; pericardial effusion; enlarged heart, S189