Eosinophilic myocarditis from a forensic histopathological perspective

Area of Science:

• Cardiology
• Pathology
• Forensic Medicine

Background:

• Eosinophilic myocarditis (EM) is a rare, potentially fatal cardiac condition characterized by eosinophil leukocyte infiltration of the myocardium.
• Its etiology is often unknown, but associations include hypersensitivity reactions, immune disorders, infections, and cancer.
• Diagnosis is frequently made postmortem due to varied symptoms and presentation.

Purpose of the Study:

• To retrospectively analyze histopathological findings in rare cases of eosinophilic myocarditis.
• To identify accompanying cardiac and other organ pathologies in EM cases.
• To evaluate demographic features, clinical presentations, and causes of death in EM.

Main Methods:

• Retrospective analysis of histopathological findings from forensic autopsies conducted between 2012 and 2020.
• Inclusion of cases diagnosed with eosinophilic myocarditis.
• Assessment of demographic data, autopsy findings, toxicological and microbiological results, and histopathology of cardiac and other organs.

Main Results:

• Eosinophilic myocarditis was identified in 12 (2.3%) of 558 myocarditis cases from 49,612 forensic autopsies.
• The mean age of affected individuals was 42.3 years (range: 3-83), with a slight male predominance.
• Histopathological findings included eosinophil infiltration and myocyte necrosis; EM was the cause of death in four cases.

Conclusions:

• Eosinophilic myocarditis is a rare cardiac disease with obscure etiopathogenesis and diverse clinical presentations.
• Postmortem histopathological examination remains crucial for diagnosing EM in sudden, unexpected deaths.
• Further research is needed to elucidate the pathogenesis and improve antemortem diagnosis of EM.