Sudden cardiac death, borderline myocarditis and molecular diagnosis: evidence or assumption?
OBJECTIVE
Sudden unexpected death autopsy is sometimes non-conclusive both from a macroscopic and from a histological point of view, even if carried out according to the guidelines for sudden cardiac death examination. Molecular biology techniques are required in this setting and may play a crucial role in reaching the final diagnosis.


METHODS
The postmortem examination and toxicology findings of the body of a young monk found dead in his cell were negative. Rare focal myocardial lymphocytic infiltrates were seen microscopically, associated with interstitial oedema. The findings were not sufficient to diagnose a myocarditis as the certain final cause of cardiac arrest. According to the recent guidelines for sudden cardiac death, a molecular investigation by polymerase chain reaction analysis was performed on samples of myocardium and spleen, with detection of parvovirus B19 DNA in the myocardium. Accordingly, a diagnosis of parvovirus B19 borderline acute myocarditis was put forward as the possible cause of sudden cardiac death.


CONCLUSIONS
In sudden death cases in which there is lack of a cause-effect relationship with the postmortem findings, the final report should be expressed as a descriptive association of evidence, not providing unreliable certainty, as the Association for European Cardiovascular Pathology recommends.
Department of Medicine and Public Health Forensic Medicine Section, University of Verona, Italy. alessandradesalvia@yahoo.com
Alessandra
A
De Salvia
Domenico
D
De Leo
Elisa
E
Carturan
Cristina
C
Basso
D000208:Acute Disease; D000328:Adult; D004279:DNA, Viral; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D049429:Forensic Pathology; D006321:Heart / Q000821:virology; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000473:pathology / Q000821:virology*; D009206:Myocardium / Q000473:pathology; D010322:Parvoviridae Infections / Q000175:diagnosis*; D016732:Parvovirus B19, Human / Q000235:genetics; D016133:Polymerase Chain Reaction; D013154:Spleen / Q000821:virology
D004279:DNA, Viral