Abstract
We report the case of an 18 year old man who unexpectedly died of healing myocarditis. His heart was hypertrophied with multifocal fibrosis which can be a common histological feature of primary and secondary cardiomyopathy as well as the healing phase of myocarditis. However, the pattern of myocardial fibrosis, inflammation with myonecrosis, sparing of the right ventricular myocardium, and cardiomyocytes features in the remaining areas of the heart were considered as the key elements in determining a diagnosis of myocarditis. This case illustrates that meticulous histologic examination and the analysis of the histologic findings in the hypertrophied heart with multifocal fibrosis can be helpful to make a correct diagnosis.
Highlights
Sudden cardiac death is one of the most common causes of death in the practice of forensic pathology
Myocarditis and cardiomyopathy including hypertrophic cardiomyopathy and arrhythmogenic ventricular cardiomyopathy are the most common underlying myocardial diseases resulting in sudden deaths in this group [4]
We presented a case of a sudden death in a young man with a hypertrophied heart and multifocal fibrosis, which was determined to be healing myocarditis that was distinguished from primary cardiomyopathy
Summary
Sudden cardiac death is one of the most common causes of death in the practice of forensic pathology. Myocarditis and cardiomyopathy including hypertrophic cardiomyopathy and arrhythmogenic ventricular cardiomyopathy are the most common underlying myocardial diseases resulting in sudden deaths in this group [4]. Vaccination may be effective in preventing some of viral myocarditis [5] As it can be genetic, it is important to confirm the specific type of primary cardiomyopathy for the deceased’s family and recommend further management. We presented a case of a sudden death in a young man with a hypertrophied heart and multifocal fibrosis, which was determined to be healing myocarditis that was distinguished from primary cardiomyopathy. The microscopic examination showed subacute lymphocytic myocarditis with evidence of early secondary cardiomyopathic changes; moderate to marked interstitial and replacement-type fibrous tissue deposition in a band-like distribution within the mid myocardial and subepicardial third in the left ventricular wall and the interventricular septum. Genetic testing was performed and was negative for the cardiomyopathy panel
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