An Update on Myocarditis in Forensic Pathology
Jessica Falleti1, Pasquale Orabona1, Maurizio Municinò2
1Patology Section, Sant'Anna e San Sebastiano Hospital, 81100 Caserta, Italy.
Insights
Diagnosing myocarditis in sudden death cases is challenging due to limited histopathological data. Improved classification and pathogen identification are crucial for accurate forensic evaluations.
Area of Science:
- Forensic Medicine
- Pathology
- Cardiology
Background:
- Myocarditis presents diagnostic challenges in forensic medicine, particularly concerning sudden death and medical malpractice.
- Accurate evaluation requires comprehensive knowledge of etiopathology, histopathology, and existing literature.
- Histomorphological data on myocarditis have historically been scarce and poorly documented, complicating death investigations.
Purpose of the Study:
- To review the literature on myocarditis in forensic contexts, highlighting diagnostic difficulties.
- To emphasize the need for improved histopathological documentation and etiological identification in myocarditis cases.
- To propose essential elements for a comprehensive understanding and diagnosis of myocarditis.
Main Methods:
- Literature review focusing on etiopathology, histopathology, and diagnosis of myocarditis in forensic medicine.
- Analysis of diagnostic challenges, including the impact of co-infections and deductive reasoning.
- Inclusion of histological images from scientific references to illustrate key aspects.
Main Results:
- The diagnosis of myocarditis as a cause of death is often difficult, leading to potential errors.
- Histopathological data improved post-COVID-19, but autopsy practices and pathogen identification remain areas for improvement.
- Four key areas are identified for better diagnosis: clinical classification, etiological classification, pathophysiology, and histopathological diagnosis.
Conclusions:
- Accurate diagnosis of myocarditis in forensic cases requires robust clinical, etiological, and histopathological data.
- Standardized autopsy practices and precise identification of myocarditis histotypes and causative agents are essential.
- Enhanced understanding of viral/bacterial infections and host responses is critical for forensic pathology.
Abstract:
In forensic medicine, myocarditis is a complicated topic in the context of sudden death and medical malpractice. A good knowledge of the etiopathology, histopathology, and available literature are both indispensable and essential for the correct management and evaluation of the causal link. Some agents, which are rarely lethal for humans, are not necessarily related to death from myocarditis, even if an infection in other organs such as the gastrointestinal tract is documented. The diagnosis of the causes of death is often difficult and confusing. In some cases, the hypothetical diagnosis of myocarditis as the cause of death is formulated by deduction, causing error and misleading the correct temporal evaluation of pathological events. We reviewed the literature realizing that histomorphological data are scarce and often poorly documented. Only after COVID-19 have the histomorphological aspects of myocarditis been better documented. This is due to poor autopsy practice and poor accuracy in identifying the specific histotype of myocarditis with identification of the responsible agent. We believe that four points are essential for a better understanding and complete diagnosis of the disease: (1) clinical classification of myocarditis; (2) etiological classification of myocarditis; (3) pathophysiology of viral and bacterial infections with host response; and (4) histopathological diagnosis with precise identification of the histotype and pathogen. In the review we provide histological images from authoritative scientific references with the aim of providing useful information and food for thought to readers.
