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Myocarditis misdiagnosed as sudden infant death syndrome (SIDS)
1Sackler Faculty of Medicine, Tel Aviv University, Israel.
Abstract:
In a retrospective study spanning five years, the histologic sections of 35 autopsies of infants diagnosed as SIDS victims were reviewed. Based on a recently reported study in which findings on marked basement membrane thickening (BMT) in the true vocal cords was suggested as a pathognomonic marker of SIDS, we expected to find BMT in all these cases. However, in seven of the reviewed autopsies (20%) no BMT was detected. Examination of new histologic sections of all the victims revealed myocarditis in these seven cases. In a control group (n = 18) of children with known cause of death, neither BMT nor myocarditis were found. The incidence of myocardial diseases in infants and young adults (20% and 22% respectively) reported in the literature indicates that myocarditis is not a rare cause of sudden death in infants. Therefore, in SIDS-suspected cases a meticulous post-mortem microscopic examination of the heart should be carried out, especially whenever BMT of the vocal cords is absent.
Insights
Sudden Infant Death Syndrome (SIDS) may be linked to myocarditis, not just vocal cord basement membrane thickening (BMT). Autopsies revealed myocarditis in 20% of SIDS cases lacking BMT, suggesting heart examination is crucial.
Area of Science:
- Forensic Pathology
- Pediatric Pathology
- Cardiovascular Pathology
Background:
- Sudden Infant Death Syndrome (SIDS) remains a significant cause of infant mortality.
- Basement membrane thickening (BMT) in vocal cords was recently proposed as a potential pathognomonic marker for SIDS.
- The differential diagnosis of SIDS requires thorough post-mortem examination to exclude other causes of sudden death.
Purpose of the Study:
- To investigate the prevalence of basement membrane thickening (BMT) in SIDS cases.
- To identify alternative pathological findings in SIDS cases where BMT is absent.
- To assess the role of myocarditis as a potential cause of sudden death in infants.
Main Methods:
- Retrospective review of histologic sections from 35 infant autopsies diagnosed with SIDS.
- Re-examination of histologic sections, including cardiac tissue, for all cases.
- Comparison with a control group of 18 children with known causes of death.
Main Results:
- Basement membrane thickening (BMT) was absent in 20% (7 out of 35) of the reviewed SIDS cases.
- Myocarditis was identified in these seven cases lacking BMT.
- Neither BMT nor myocarditis was found in the control group.
Conclusions:
- Basement membrane thickening (BMT) is not universally present in SIDS cases.
- Myocarditis is a significant finding in a subset of SIDS-suspected deaths.
- Post-mortem microscopic examination of the heart is essential in SIDS investigations, particularly when BMT is absent.