Suspected cot death and diagnosis of myocarditis

Background: During the last years immunohistochemical techniques have impro ved the diagnosis of myocarditis using specific markers for quantification of leucocytes and characterization of T-lymphocytes together with the defin ition of MHC class II Antigens (HLA-DP, DQ, DR), known to be enhanced in ca ses of myocarditis. These techniques allow the diagnosis of myocarditis in an early stage of the inflammatory process in contrast to the conventional diagnostic with hematoxylin-eosin. Materials and methods: 20 autopsy cases were examined in a retrospective st udy with conventional histological and irmnunohistological methods. After r outine investigations including toxicological and histological examination of internal organs all cases were considered as cases of Sudden Infant Deat h Syndrome (SIDS). Results: Increased number of LCA-positive leucocytes and CD-3-positive T-ly mphocytes together with enhanced expression of inflammatory marker leads to the diagnosis of a lymphomonocytic myocarditis in three cases, in one case myocarditis could be diagnosed by conventional hematoxylin-eosin staining. In one of these four cases of myocarditis a positive immunohistochemical r eaction was found using a new antibody against enteroviruses. Conclusion: Immunohistochemical techniques improve diagnosis of myocarditis in cases of suspected sudden infant death syndrome. Further studies using immunohistochemical inflammatory markers to control the incidence of acute myocarditis are necessary.