Unexpected Death in a Preschool Child: Forensic Assessment of Acute Myocarditis on Left Ventricular Hypertrophy

Myocarditis is an inflammatory disease of the myocardium with a highly variable clinical spectrum, ranging from mild or subclinical forms to severe manifestations, including heart failure, arrhythmias, and sudden cardiac death. In this article, we report a case of sudden death in a 4-year-old child in whom autopsy and histopathologic investigations identified myocarditis developing on a substrate of left ventricular hypertrophy. Given the lack of pathognomonic symptoms in myocarditis, maintaining a high index of clinical suspicion is paramount for ensuring timely admission. Early diagnosis is crucial to initiating treatment before clinical deterioration occurs. Furthermore, implementing standardized and systematic autopsy analysis is essential to maximizing the diagnostic yield in cases of unexpected death in childhood. In the absence of a unified investigative framework and multidisciplinary approach, postmortem examinations risk remaining incomplete, potentially leaving critical pathologic findings undetected.