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Sudden, Unexpected Death Related to Viral Myocarditis

A Survey of Histological, Immunohistochemical, and Molecularpathological Methods for the Postmortem Diagnosis
  • Reinhard Dettmeyer
  • Burkhard Madea
Part of the Forensic Pathology Reviews book series (FPR, volume 2)

Abstract

Sudden, unexpected deaths of previously healthy individuals without establishment of a definitive acute lethal event at autopsy represent a substantial proportion of forensic autopsy cases. It is well established that viral myocarditis can be associated with sudden, unexpected manifestation of death. Nevertheless, this diagnosis may present difficulties when there are no relevant histological findings using conventional histological stains. When applying a comprehensive combination of molecularpathological and immunohistochemical techniques, obviously a higher prevalence of viral myocarditis can be detected with regard to forensic pathological autopsy cases. Immunohistochemical methods include qualification and quantification of interstitial leukocytes including macrophages, T-lymphocytes, and the expression of adhesion molecules and cytokines as well as major histocompatibility complex class I and II molecules. Conventional histology may provide, when supplemented by immunohistochemistry, important clues regarding the underlying etiology of myocarditis. The actual demonstration of microorganisms in the myocardium or the elucidation of a previous administration of drugs or exposure to toxic substances are the only reliable means of establishing an etiological diagnosis of myocarditis. Molecularpathological techniques should be employed particularly for the detection of viral genome in the myocardium by reverse transcriptase polymerase chain reaction (rt-PCR) as already established regarding the investigation of endomyocardial biopsies. In combination with histological, immunohistochemical, and in situ hybridization, these techniques will enable the forensic pathologist or medical examiner, respectively, to clarify the cause of death in a higher number of cases of sudden, unexpected death that present otherwise without any relevant morphological findings.

Key Words

Sudden death myocarditis immunohistochemistry molecularpathology polymerase chain reaction (PCR) forensic pathology 

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Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • Reinhard Dettmeyer
    • 1
  • Burkhard Madea
    • 1
  1. 1.Institute of Forensic MedicineRheinische Friedrich-Wilhelms-University BonnBonnGermany

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