title: Fulminant Peripartum myocarditis associated with sudden cardiac death: a case report.
abstract: Myocarditis is an inflammatory disease of myocardium, associated with nonischemic necrosis and degeneration of myocytes. Although the clinical course is rapid, myocarditis can lead to dilated cardiomyopathy with chambers dilatation and ventricular dysfunction. The pathophysiology of myocarditis in humans is not completely understood. There are several etiological agents implicated, mainly viral agents. The clinical presentation is extremely various, with nonspecific systemic symptoms until sudden death. The great variability of symptoms makes the diagnosis, therefore, extremely difficult. We report the case of a 40-year-old woman who developed, after childbirth, hyperthermia associated with neck and left arm pain; initially treated with acetaminophen, without any benefit, the young woman, after few days, died suddenly. The autopsy documented the presence of edematous lungs and enlarged and congested liver. The microbiological tests performed 4 days after death were negative. The heart was normal in shape and volume; a section of the left ventricle wall showed subendocardial discromic areas histologically characterized by multifocal perivascular and interstitial inflammatory infiltrates. These infiltrates consisted mainly of neutrophils with eosinophil component associated with myocyte necrosis and hemorrhagic interstitial infiltration.
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, P.zza G. Cesare, 11, 70124 Bari, Italy.
authors.forename: Marco Matteo
authors.initials: MM
authors.lastname: Ciccone
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, P.zza G. Cesare, 11, 70124 Bari, Italy. Electronic address: ilaria.dentamaro@hotmail.it.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Dentamaro
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, P.zza G. Cesare, 11, 70124 Bari, Italy.
authors.forename: Santa
authors.initials: S
authors.lastname: Carbonara
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, P.zza G. Cesare, 11, 70124 Bari, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ricci
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, P.zza G. Cesare, 11, 70124 Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Vestito
authors.affiliation: Department of Emergency and Organ Transplantation, Pathology Division, University of Bari, P.zza G. Cesare, 11, 70124 Bari, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marzullo
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, P.zza G. Cesare, 11, 70124 Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tunzi
authors.affiliation: Department of Interdisciplinary Medicine, Section of Legal Medicine, University of Bari, P.zza G. Cesare, 11, 70124 Bari, Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Solarino
mesh_terms: D000328:Adult; D001344:Autopsy; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009205:Myocarditis / Q000473:pathology*; D058725:Peripartum Period; D011247:Pregnancy
keywords: Forensic pathology; Peripartum myocarditis; Pregnant complications; Sudden death