Elsevier

Cardiovascular Pathology

Volume 17, Issue 2, March–April 2008, Pages 117-123
Cardiovascular Pathology

Case Report
Atherosclerotic oxalosis in coronary arteries,☆☆,

https://doi.org/10.1016/j.carpath.2007.07.002Get rights and content

Abstract

Background

Systemic oxalosis may be hereditary or acquired. In these cases, calcium oxalate deposits have been reported in numerous tissues, including the media of arteries. In any category, calcium oxalate deposition has not been described within atherosclerotic plaques in any arteries.

Methods

As part of a retrospective clinicopathologic study, 80 hearts were obtained from the National Neurological AIDS Bank in an effort to study coronary atherosclerosis in patients infected with HIV. The population consisted of 66 HIV-positive and 14 HIV-negative patients with an average age of 47 years; 79% were males. Proximal coronary arteries were serially sectioned and processed routinely. Sections were studied by hematoxylin and eosin staining and, in selected cases, von Kossa stain and alizarin red S under different conditions, including polarized light, to allow distinction of calcium phosphate from calcium oxalate. Medical histories, autopsy reports, and general autopsy slides were reviewed.

Results

In four patients (three with AIDS), calcium oxalate crystals were observed within atherosclerotic plaques in the coronary arteries. Similar deposits were seen in the thyroid gland and other organs but not in the kidneys. None of the patients had chronic renal failure.

Conclusion

The calcium oxalate crystal deposits observed in the atherosclerotic plaques in the coronary arteries of these four patients are unique in two ways: (a) these deposits have not previously been described in atherosclerotic plaques; (b) the patients did not demonstrate any of the recognized patterns of oxalosis. We suggest the phrase “atherosclerotic oxalosis” to describe this finding.

Introduction

Oxalosis is the accumulation of crystalline deposits of calcium oxalate in tissues. Precipitation of calcium oxalate occurs when the solubility of this highly insoluble salt is exceeded. There are several subclassifications of oxalosis, collectively involving a wide distribution of tissues. It is the purpose of this document to describe what we believe to be a new site of involvement not previously reported, the atherosclerotic plaque. We report four cases in which oxalate crystals were observed in coronary artery atherosclerotic plaques. The patients were being studied as part of an investigation into the relationship of coronary atherosclerosis and HIV/AIDS.

Section snippets

Methods

Heart specimens were obtained from the National Neurological AIDS Bank as part of a study of coronary atherosclerosis in HIV-infected patients. The population consisted of 66 HIV-positive and 14 HIV-negative patients with an average age of 47 years; 79% were male. Coronary arteries were fixed in formalin, decalcified when necessary, and cut serially every 2–3 mm. The proximal 2 cm of the left anterior descending, 2 cm of the left circumflex, 3 cm of the right coronary artery, and the entirety

Case 1

The patient, a 49-year-old male, had a 21-year history of HIV and an 11-year history of AIDS prior to death from pneumonia and respiratory complications. Highly active antiretroviral therapy (HAART), including multiple protease inhibitors, had been prescribed. Additionally, the patient developed secondary progressive multifocal leukoencephalopathy. Coronary arteries showed oxalate crystal deposits within atherosclerotic plaques. Oxalate crystals were also clearly present in a mediastinal lymph

Discussion

Oxalosis can be hereditary or acquired. Hereditary oxalosis, or primary hyperoxaluria, is a general term for at least three rare autosomal recessive disorders. Types I and II primary hyperoxaluria are alterations of glycoxalate metabolism resulting in the production of excess oxalate ions. Type III primary hyperoxaluria is caused by increased oxalate absorption by the gastrointestinal tract [2]. All three types are characterized by chronic renal failure and, usually, death at a young age. In

Summary

There are many forms of oxalosis, with deposition of oxalate crystals in various organs, including arteries. In this retrospective study, we describe deposition of calcium oxalate crystals within atherosclerotic plaques in coronary arteries of four patients, a site of oxalate deposition not previously reported. We suggest the phrase “atherosclerotic oxalosis” for this finding.

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Cited by (0)

This work was done while Mr. Fishbein and Mr. Micheletti were visiting student research scientists at UCLA.

☆☆

This work was supported by a generous endowment from the Piansky Family Trust (M.C.F.) and by NIH K24 AI056933 (J.S.C.).

The National Neurological AIDS Bank (NS-38841) provided tissue samples and Dr. Singer's support.

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