Complex vascular lesions at autopsy in a patient with phentermine-fenfluramine use and rapidly progressing pulmonary hypertension

Anorectic agents, such as aminorex and fenfluramine derivatives, have been associated previously with the development of primary pulmonary hypertensio n. The combination diet drug phentermine-fenfluramine (or "phen-fen") was r ecently marketed in the United States. We describe a case of a 39-year-old woman with rapidly progressing, fatal pulmonary hypertension following admi nistration of phentermine-fenfluramine. Autopsy was remarkable for complex pulmonary vascular lesions most consistent with thrombotic arteriopathy.