A case report of lethal post-viral lymphocytic myocarditis with exclusive location in the right ventricle

•Myocarditis is an acute inflammation of the myocardium and can be asymptomatic.•Autopsy may be unremarkable and diagnosis is based on microscopic diagnosis.•The case reports a lymphocytic myocarditis of the right ventricle.•The article highlights the importance of the microscopy of the right ventricle.

The inflammatory involvement of vital organs may represent a dangerous and life-threatening situation: in particular, the inflammation of the myocardial tissue of the heart may lead to severe consequences since the clinical history of the disease may be completely asymptomatic, any clinical sign may be lacking, thus preventing correct diagnosis and treatment. This may occur even in the case of myocarditis and may lead to unexpected death whose cause can be assessable only by means of a thorough histopathological examination. The article reports the case of 61-year old female who developed a flu-like syndrome with very few symptoms, followed by sudden death in three weeks. The autopsy and following histopathological investigations identified the cause of death in a post-viral lymphocytic myocarditis, probably related to the previous infectious disease, and alternative causes (as arrhythmic ventricular dysplasia, vasculitis, sarcoidosis and giant cell myocarditis) were excluded. The exclusive location in the right ventricle was a peculiar finding. The case highlights the importance of the myocardium of the right ventricle, a tissue which is often less considered even in histopathological surveys. The exclusive location of myocarditis in the right ventricle is a rare event but in this case fully responsible for death.

Graphical abstractAlternative differential diagnosis excluded: ARVD, vasculitis, giant cell myocarditis, myocardial infarction and other causes of acute heart failure.Figure optionsDownload full-size imageDownload high-quality image (242 K)Download as PowerPoint slide