Case ReportsSpontaneous Multiple Arterial Dissection in a COVID-19–Positive DecedentJames, Christine DO; Peterson, Diane C. MD Author Information From the Johnson County Medical Examiner's Office, Olathe, KS. Manuscript received February 23, 2021; accepted March 27, 2021. The authors report no sources of support. The authors report no conflict of interest. Reprints: Christine James, DO, Johnson County Medical Examiner's Office, 11894 S. Sunset Drive, Olathe, KS 66061. E-mail: [email protected]. The American Journal of Forensic Medicine and Pathology: March 2022 - Volume 43 - Issue 1 - p 52-54 doi: 10.1097/PAF.0000000000000737 Buy Metrics Abstract 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. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.