title: Fulminant myocarditis demonstrating uncommon morphology--a report of two autopsy cases.
abstract: 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.
authors.affiliation: Pathology, Mito Saiseikai General Hospital, 3-3-10 Futabadai, Mito, 311-4198 Ibaraki, Japan. oka-k@gb3.so-net.ne.jp
authors.forename: Kuniyuki
authors.initials: K
authors.lastname: Oka
authors.forename: Koji
authors.initials: K
authors.lastname: Oohira
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yatabe
authors.forename: Toshio
authors.initials: T
authors.lastname: Tanaka
authors.forename: Kozo
authors.initials: K
authors.lastname: Kurano
authors.forename: Rie
authors.initials: R
authors.lastname: Kosugi
authors.forename: Minoru
authors.initials: M
authors.lastname: Murata
authors.forename: Hando
authors.initials: H
authors.lastname: Hakozaki
authors.forename: Toshio
authors.initials: T
authors.lastname: Nishikawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tsutsumi
mesh_terms: D000328:Adult; D000818:Animals; D001344:Autopsy; D002114:Calcinosis / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D036022:Capsid Proteins / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D009205:Myocarditis / Q000473:pathology* / Q000503:physiopathology / Q000821:virology*; D010849:Picornaviridae / Q000235:genetics*; D010850:Picornaviridae Infections / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D012367:RNA, Viral; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D036022:Capsid Proteins; D012367:RNA, Viral