Virchows Archiv

, Volume 446, Issue 3, pp 259–264 | Cite as

Fulminant myocarditis demonstrating uncommon morphology—a report of two autopsy cases

  • Kuniyuki OkaEmail author
  • Koji Oohira
  • Yasushi Yatabe
  • Toshio Tanaka
  • Kozo Kurano
  • Rie Kosugi
  • Minoru Murata
  • Hando Hakozaki
  • Toshio Nishikawa
  • Yutaka Tsutsumi
Original Article


Two autopsy cases of fulminant myocarditis demonstrating uncommon morphology were studied. Subjects included two male patients: a 42-year-old (case 1) and a 39-year-old (case 2). Both cases had fever, chest or epigastric pain, electrocardiographic abnormalities, prominent elevation of serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, lactic dehydrogenase and creatine phosphokinase. They were treated with intra-aortic balloon pumping and percutaneous cardiopulmonary support, and they died at 3 days and 4 days after admission (total course of 10 days and 9 days), respectively. Case 1 showed focal necrosis, severe myocardial dystrophic calcification positive for Kossa stain, inflammatory edema, lymphocyte and macrophage infiltration and extravasation of erythrocytes. Case 2 showed acute inflammation and severe myocardial necrosis with neutrophilic abscess, lymphocyte and macrophage infiltration, cell debris and purulent exudate. Calcified, degenerative and necrotic cardiac myocytes and macrophages were reacted with anti-Enterovirus antibody (clone 5-D8/1), which recognizes an epitope on the VP1 peptide of most Coxsackievirus, echovirus, poliovirus and enterovirus strains. Therefore, the present two cases may be compatible with fulminant enterovirus-associated myocarditis. Using reverse transcriptase-semi-nested polymerase chain reaction, picornaviral RNA was detected in the amplified products extracted from the paraffin-embedded myocardial sample of case 1 but not in case 2.


Fulminant myocarditis Enteroviruses VP1 Picornaviral RNA Dystrophic calcification 



This study was supported by a grant-in aid from Mito Saiseikai General Hospital, MSGH, Mito, and TAKE-TOSHI Medical Research Fund, Oyama, Tochigi, Japan. The authors thank Drs. H. Hanawa, E. Itoh, and S. Abe (Department of Cardiology, Niigata University School of Medicine, Niigata, Japan) for thoughtful advice, and Mrs. T. Kawasaki, W. Tanno, H. Yonekawa, Mrs. S. Koyamatsu, Miss T. Tobita and Mrs. M. Koshihara (Pathology, MSGH) for skillful technical assistance and Mr. D. Mrozek (Medical English Service, Kyoto, Japan) for English revision.


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Kuniyuki Oka
    • 1
    Email author
  • Koji Oohira
    • 2
  • Yasushi Yatabe
    • 3
  • Toshio Tanaka
    • 4
  • Kozo Kurano
    • 2
  • Rie Kosugi
    • 2
  • Minoru Murata
    • 2
  • Hando Hakozaki
    • 5
  • Toshio Nishikawa
    • 6
  • Yutaka Tsutsumi
    • 7
  1. 1.PathologyMito Saiseikai General HospitalIbaraki Japan
  2. 2.CardiologyMito Saiseikai General HospitalIbarakiJapan
  3. 3.Department of Pathology and Molecular DiagnosticsAichi Cancer Center HospitalAichiJapan
  4. 4.Department of Infection and ImmunologySRL Inc.TokyoJapan
  5. 5.PathologyFukushima Rosai HospitalFukushimaJapan
  6. 6.Department of PathologyTokyo Women Medical CollegeTokyoJapan
  7. 7.Department of PathologyFujita Health University School of MedicineAichiJapan

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