Department of Pathology, The Council of Forensic Medicine, Istanbul, Turkey.
J Forensic Sci. 2023 Mar;68(2):500-508. doi: 10.1111/1556-4029.15197. Epub 2023 Jan 12.
Eosinophilic myocarditis (EM) is a rare and potentially fatal form of myocarditis characterized by infiltration of the myocardium with eosinophil leukocytes, often accompanied by eosinophilia. Although the exact underlying cause remains unknown, it has been shown to be associated with hypersensitivity reactions, immune-mediated disorders, infections, or cancer. Due to the differences in symptomatology, it is often diagnosed by postmortem histopathological examination. We aimed to retrospectively examine the histopathological findings of rare cases of EM and to detect accompanying cardiac and other organ pathologies. The histopathological findings of the cases that underwent autopsies between 2012 and 2020 and were diagnosed with EM were assessed. Demographic features, symptoms, causes of death, macroscopical findings at autopsy, toxicologic and microbiological analysis results, accompanying cardiac pathologies, and histopathological findings in other organs were evaluated. Myocarditis was detected on histopathologic examination in 558 (1.1%) of 49,612 forensic autopsies. There were 12 (2.3%) EM cases. There were nine males and four females. The mean age was 42.3 (3-83) years. Heart weights ranged from 82 to 564 g. The most common finding on macroscopic examination was the mottled discoloration and scarring in the myocardium. Microscopic examination revealed perivascular and interstitial infiltration of eosinophils in all of the cases accompanied by myocyte necrosis in four of them. EM was reported as the cause of death in four cases. EM remains a challenging heart disease with its obscure etiopathogenesis and varying clinical presentation and a rare entity diagnosed by postmortem histopathological examination in sudden and unexpected deaths.
嗜酸性心肌炎（EM）是一种罕见且潜在致命的心肌炎形式，其特征是心肌中浸润嗜酸性粒细胞白细胞，常伴有嗜酸性粒细胞增多。尽管确切的根本原因尚不清楚，但已表明它与过敏反应、免疫介导的疾病、感染或癌症有关。由于症状不同，它通常通过死后组织病理学检查来诊断。我们旨在回顾性检查罕见 EM 病例的组织病理学发现，并检测伴随的心脏和其他器官病理学。评估了 2012 年至 2020 年间进行尸检并诊断为 EM 的病例的组织病理学发现。评估了人口统计学特征、症状、死因、尸检时的大体发现、毒理学和微生物学分析结果、伴随的心脏病理学以及其他器官的组织病理学发现。在 49612 例法医尸检中，有 558 例（1.1%）在组织病理学检查中发现心肌炎。有 12 例（2.3%）嗜酸性心肌炎病例。有 9 名男性和 4 名女性。平均年龄为 42.3（3-83）岁。心脏重量范围为 82 至 564 克。大体检查最常见的发现是心肌斑驳变色和瘢痕。显微镜检查显示所有病例均有血管周围和间质嗜酸性粒细胞浸润，其中 4 例伴有心肌细胞坏死。有 4 例报告 EM 是死因。EM 仍然是一种具有挑战性的心脏病，其病因发病机制不明确，临床表现多样，在突然和意外死亡的死后组织病理学检查中是一种罕见的实体。
