Ben Khelil Mehdi, Chkirbene Youssef, Mlika Mona, Haouet Slim, Hamdoun Moncef
From the *Department of Forensic Medicine, Charles Nicolle Hospital; †Faculty of Medicine, University Tunis El Manar; and ‡Department of Pathology, La Rabta Hospital, Tunis, Tunisia.
Am J Forensic Med Pathol. 2017 Mar;38(1):29-31. doi: 10.1097/PAF.0000000000000288.
Drug-induced eosinophilic myocarditis is uncommon with few cases reported in the literature. It is a rare but potentially life-threatening disease.We report the case of an 11-year-old girl without medical history who developed an acute malaise and chills, followed by severe shortness of breath and a cardiopulmonary arrest 1 hour after an intramuscular injection of penicillin.At autopsy, we observed in the external examination nonspecific asphyxia signs, an injection mark, and the absence of traumatic signs. The organs examination showed a heart with a normal shape and a transmural, diffuse, tannish discoloration of the myocardium. The lungs were severely congested with a diffuse edema. Histological examination of the ventricular walls and septum revealed suggestive signs of eosinophilic myocarditis. Immunohistochemical analysis for the phenotypic characterization of the inflammatory cells revealed the positivity of the CD3 antibody without any stain for CD20.The diagnosis of fulminant myocarditis with an eosinophilic infiltrate was established as the cause of death. The manner of death was stated as natural.
药物性嗜酸性粒细胞性心肌炎并不常见，文献中报道的病例很少。它是一种罕见但可能危及生命的疾病。我们报告了一名11岁无病史女孩的病例，她在肌肉注射青霉素1小时后出现急性不适和寒战，随后出现严重呼吸急促和心肺骤停。尸检时，我们在外部检查中观察到非特异性窒息迹象、注射痕迹，且无创伤迹象。器官检查显示心脏形状正常，心肌有透壁性、弥漫性、淡黄色变色。肺部严重充血并伴有弥漫性水肿。对心室壁和室间隔的组织学检查显示有嗜酸性粒细胞性心肌炎的提示性迹象。对炎症细胞进行表型特征分析的免疫组织化学分析显示CD3抗体呈阳性，而CD20无染色。确诊暴发性心肌炎伴嗜酸性粒细胞浸润为死因。死亡方式判定为自然死亡。
