Acute petrified myocardium associated with meningococcal sepsis in childhood-onset systemic lupus erythematous: a fatal case

Abstract

Acute petrified myocardium associated with septic shock, diagnosed by autopsy has rarely been described. A 15-year-old adolescent male was diagnosed with childhood-onset systemic lupus erythematosus. One year later, he was hospitalized with fever, myalgia, headache, arthritis, vomiting, dyspnea and was diagnosed with sepsis secondary to bronchopneumonia and meningitis. Blood culture identified Neisseria meningitidis serogroup Y. Despite antibiotics and intensive therapeutic measures, he died after 29 days of hospitalization. The autopsy revealed necrotic cardiomyocytes with dystrophic calcification and interstitial fibrosis.

Major discrepancy between clinical diagnosis of death and anatomopathological findings in adolescents with chronic diseases during 18-years

“…We also did not evaluate autopsy microbiology, since systematic analyses of molecular diagnosis and molecular biology in anatomopathological fragments are relevant to identify specific infectious agents. [25] Further studies will be necessary to clarify this issue.…”

“…Fungal and viral infections are relevant for hospitalized patients with neoplasia, chronic liver, rheumatic and infectious diseases. [ 2 , 3 , 4 , 6 , 8 , 22 , 23 , 24 , 25 ] Furthermore, antifungal therapy was used in half of the adolescents with Goldman Classes I or II, and may have influenced the higher frequencies of misdiagnoses of these infections in the groups with major discrepancies.…”

Risk factors for mortality in 1528 Brazilian childhood-onset systemic lupus erythematosus patients

“…8,15,16,[47][48][49] Autopsies were performed in only 19% of deceased patients, due to familial refusal related to religious beliefs, ethical and bureaucratic aspects, but, surprisingly, they showed undiagnosed manifestations in more than half of the cases. 50 Therefore, autopsy should always be recommended due to its relevance in determining events not clarified at the time of death, and also due to the importance of identifying underlying conditions. 21,22 The main limitations of our study were the retrospective design, the presence of missing data, along with follow-up loss or occurrence of deaths from unknown causes.…”

Relação entre laudos clínicos e autópsias em adolescentes com doenças crônicas de um centro terciário

“…Além disto um potencial para viés de seleção é que apenas 15% dos adolescentes que morreram no período do estudo foram submetidos à autópsia. Também não foram avaliadas as microbiologias das autópsias, uma vez que análises sistemáticas de diagnóstico molecular e biologia molecular em fragmentos anatomopatológicos são relevantes para identificar agentes infecciosos específicos 25 . Futuros estudos serão necessários para identificar os agentes etiológicos infecciosos de cada autopsia, utilizando microscopia eletrônica, novas técnicas moleculares e genéticas.…”