Coxsackie B3 myocarditis in a case of sudden unexpected death in young athlete: histopathological, immunohistochemical and molecularpathological for diagnosis

Abstract

Virus-induced myocarditis is a common disease even in infants and young adults, but the diagnosis can be difficult according to the Dallas-criteria, which have been criticized as being too unreliable. The diagnosis has been substantially improved due to immunohistochemistry (IHC) for the detection of the VP1-capsid-protein of enterovirus as well as reversetranscriptase-polymerase chain reaction assays (RT-PCR) for viral genome detection. We report an unusual case of myocarditis in a young adult athlete whose heart disease was not clinically recognized and, thus, caused his sudden unexpected death (SUD). Histopathological investigations of heart tissue samples revealed signs of myocarditis. IHC was used to detect the VP1-capsid-protein of enterovirus. RT-PCR assays were used to detect enterovirus RNA. Enterovirus myocarditis was determined as a cause of death.