Lethal enterovirus-induced myocarditis and pancreatitis in a 4-month-old boy

• Published in: Forensic science international 2006-01, Vol.156 (1), p.51-54
• Main Authors: Dettmeyer, R.B., Padosch, S.A., Madea, B.
• Format: Article
• Language: English
• Subjects: alpha 1-Antitrypsin - analysis; Antibodies, Antinuclear - blood; Apnea - virology; Biological and medical sciences; Bradycardia - virology; Child, Preschool; Diarrhea - virology; Enterovirus; Enterovirus - isolation & purification; Enterovirus Infections - diagnosis; Enteroviruses; Family medical history; Fatal Outcome; Fatalities; Fever - virology; Forensic medicine; Forensic Pathology; Forensic sciences; General aspects; Heart - virology; Humans; Hypotension - virology; Hypothermia - virology; Investigative techniques, diagnostic techniques (general aspects); Leukocyte Count; Liver - virology; Lymphocytes; Male; Medical sciences; Myocarditis; Myocarditis - virology; Myocardium - immunology; Myocardium - pathology; Pancreas; Pancreas - immunology; Pancreas - pathology; Pancreas - virology; Pancreatic Elastase - blood; Pancreatitis; Pancreatitis - virology; Pathogenesis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rodents; Sudden infant death syndrome; Sudden infant death syndrome (SIDS); Viral infections; Vomiting - virology
• ISSN: 0379-0738; 1872-6283
• DOI: 10.1016/j.forsciint.2004.12.015

After inconspicuous pregnancy and birth, a 16-year-old mother presented her male baby 5 days later with severe diarrhoea and vomiting. During the following weeks, the child temporarily showed hypotension, hypothermia and increased body temperature, bradyarrythmia with apnoea, continuing diarrhoea, sometimes vomiting and developed signs of pancreatic insufficiency. Due to increasing loss of weight and obviously severe dystrophia, parenteral nutrition had to be initiated. All clinical investigations revealed no underlying disease. Numerous biopsies, mainly from the gastrointestinal tract were taken, but no relevant pathological findings were disclosed. The baby was found lifeless by his mother, 4 months after birth. According to the death certificate, the physicians regarded the lethal outcome as a case of sudden infant death syndrome (SIDS). Histological and immunohistochemical investigations of organ samples revealed signs of myocarditis, pancreatitis and focal pneumonia. Molecularpathological techniques were used to detect enterovirus RNA from tissue samples from the myocardium, liver and pancreas. Enteroviral myocarditis with concomitant pancreatitis was determined as cause of death.