Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, 40126, Italy.
Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, 42122, Italy.
Forensic Sci Med Pathol. 2024 Mar;20(1):219-225. doi: 10.1007/s12024-023-00659-6. Epub 2023 Jun 19.
We present the case of a 23-month-old child who died less than 24 h after the onset of cardiac symptoms, despite being admitted to the hospital 72 h earlier. Autopsy revealed no significant macroscopic changes, and histologic examination revealed focal lymphocytic myocarditis with myocyte disruption, diffuse alveolar damage in the exudative phase, and generalized lymphocytic immune activation in other organs. Ante-mortem and post-mortem microbiological exams did not clearly prove a causative role of infectious agents. The peculiarity of this case was characterized by the contrast between the severe clinical features and the mild cardiac histological findings. This discrepancy, coupled with the suspicion of a viral causative role based on both ante-mortem and post-mortem microbiological examinations, presented significant challenges in reaching an etiological diagnosis. This case also confirms that the diagnosis of myocarditis in children cannot be made solely on the basis of histological cut-offs or microbiological results. Using abductive reasoning, various diagnostic hypotheses were formulated and evaluated to arrive at the final diagnosis of fatal myocarditis of viral or post-viral origin. Data from post-mortem examination are often the only source of information that is available to the experts, especially in cases of sudden infant death syndrome. In such cases, the forensic pathologists should accurately evaluate findings that may appear to indicate a different etiology, and, in the absence of clinical or radiological data, interpret post-mortem data in a logically correct manner. The autopsy is the first essential step to evaluate the cause of death and must be integrated with the results of ante- and post-mortem diagnostic tests in a holistic approach, which is crucial to allow forensic pathologists to provide an appropriate and relevant opinion.
我们报告了一例 23 个月大的婴儿病例，其在出现心脏症状不到 24 小时后死亡，尽管他在发病后 72 小时前就已入院。尸检未发现明显的宏观变化，组织学检查显示局灶性淋巴细胞性心肌炎伴心肌破坏、渗出期弥漫性肺泡损伤以及其他器官的广泛淋巴细胞免疫激活。生前和死后的微生物学检查均未能明确证明感染因子的致病作用。该病例的特点是严重的临床特征与轻度心脏组织学发现之间的对比。这种差异，加上基于生前和死后微生物学检查怀疑病毒的致病作用，给确定病因诊断带来了重大挑战。该病例还证实，儿童心肌炎的诊断不能仅基于组织学截止值或微生物学结果。通过溯因推理，提出了各种诊断假设并进行了评估，最终诊断为病毒性或病毒性后心肌炎。尸检后获得的信息通常是专家唯一可用的信息来源，尤其是在婴儿猝死综合征的情况下。在这种情况下，法医病理学家应准确评估可能表明不同病因的发现，并在缺乏临床或影像学数据的情况下，以逻辑正确的方式解释死后数据。尸检是评估死因的第一步，必须与生前和死后的诊断测试结果相结合，采用整体方法，这对于法医病理学家提供适当和相关的意见至关重要。
