When is myocarditis indeed the cause of death?. (April 2018)

• Record Type: Journal Article
• Authors: Bonsignore, Alessandro; Palmiere, Cristian; Buffelli, Francesca; Maselli, Eloisa; Marzullo, Andrea; Fraternali Orcioni, Giulio; Ventura, Francesco; De Stefano, Francesco; Dell'Erba, Alessandro
• Is Part Of: Forensic science international. Volume 285(2018)
• Page Start: 72
• Page End: 76
• Publication Date: 2018-04
• Subjects: Myocarditis -- Cause of death -- Incidence -- Autopsy -- Histopathology; Medical jurisprudence -- Periodicals; Chemistry, Forensic -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Chimie légale -- Périodiques; Gerechtelijke geneeskunde; Gerechtelijke chemie; Gerechtelijke psychiatrie; Chemistry, Forensic; Medical jurisprudence; Electronic journals; Periodicals; Electronic journals; 614.1
• DOI: 10.1016/j.forsciint.2018.01.027
• Languages: English
• ISSNs: 0379-0738

Abstract

Highlights: Attribution of death to myocarditis continues to be a controversial issue. There is a lack of uniformity in the samples chosen for reaching the cause of death. Myocarditis may occur together with many diseases: a strong evidence is required. Focal myocarditis explains the death when alternative causes of death are excluded. Abstract: Attribution of death to myocarditis continues to be a controversial issue in forensic pathology, despite the existence of established histopathological criteria as well as complementary investigations. The aim of the study was two-fold: (a) to retrospectively analyse the data obtained from a series of clinical and forensic autopsies in order to assess the number of cases with death attributed to myocarditis, and (b) to reevaluate these cases in order to assess how properly the histopathological diagnosis of myocarditis conformed to established criteria and therefore how accurately these were used on the basis of all postmortem investigation findings to conclude the cause of death. 2474 clinical and forensic autopsies were taken into consideration. Myocarditis was recorded as the official, underlying cause of death in 48 cases. Of those, 8 cases were considered to accurately conform to the histopathological Dallas criteria for the presence of myocarditis and could therefore be classified as cases of fatal myocarditis. In 19 out of 48 cases, description of focal myocarditis was considered to accurately fulfill the histopathological Dallas criteria for the presence of myocarditis. However, data provided by histological analysis and virology testing result reevaluation allowed alternative causes of death to be speculated. In another 21 out of 48 cases, description of focal myocardial inflammation was considered to inaccurately meet the histopathological Dallas criteria for the presence of myocarditis. The findings of our own study appear to be in agreement with previous observations in similar study groups and highlight that since myocarditis may occur in association with many diseases, a great deal of evidence is required before settling on categorical conclusions.