Focal lymphocytic myocarditis in acquired immunodeficiency syndrome (AIDS): A correlative morphologic and clinical study in 26 consecutive fatal cases

Abstract

In 26 consecutive cases with acquired immunodeficiency syndrome (AIDS) the main cardiac findings were Kaposi's sarcoma in 2 cases, microfocal myocardial abscess in 1, subendocardial infarct necrosis in 2, contraction band necrosis in 13, lymphocytic myocarditis in 9, intramyocardial lymphocytic infiltrates without myocell necrosis in 7 and epicardial lymphocytic infiltrates in 4. No patient had congestive heart failure. However, two-dimensional echocardiography performed in eight patients demonstrated functional abnormalities in six (fractional shortening ranging from 18 to 30%, globular shape, hypokinesia, mild ventricular dilation). Four of these six patients had lymphocytic myocarditis and two had lymphocytic infiltrates in the myocardium and epicardium without myocell necrosis. No lymphocytic infiltrates were seen in the two cases with a normal echocardiogram. Quantitative analysis indicated that involvement of the heart by lymphocytic myocarditis is inadequate in itself to explain dysfunction. It remains to be established 1) whether lymphocytic myocarditis is a possible indication of a more widespread molecular disorder, and 2) what its eventual relation with dilated cardiomyopathy will be.

Myocardial necrosis and cocaine

“…This control group was selected since AIDS patients, irrespective of concurrent opportunistic diseases show contraction band necrosis and lymphocytic myocarditis [1]. Toxicological tests were negative for all subjects.…”

Myocarditis in HIV Positive Patients

“…Toxoplasma gondii (T gondii) is the most frequently documented infectious cause of myocarditis associated with AIDS, and the heart is the second most common site of infection after the brain. Autopsy series have described T gondii myocarditis (myocardial toxoplasmosis) in 1% to 16% of patients dying of AIDS [Baroldi et al, 1988, Anderson et al, 1988, Matturi et al, 1990. Evidence of myocardial toxoplasmosis includes trophozoites or pseudocysts in myocardial fibers.…”

Clinical Presentation

“…On the other hand, disorders such as hypertension, hyperglycemia, hyperlipidemia, lipodystrophy and coronary artery disease appeared to add further comorbidity to HIV infection (Fisher & Lipshultz, 2001;Friis-Møller et al, 2007;Tershakovec et al, 2004). Human immunodeficiency virus is the most common cardiac pathologic finding at autopsy in HIV infected patients with prevalence as high as 70 percent (Anderson et al, 1988;Baroldi et al, 1988, Lewis, 1989. Myocarditis identified at autopsy or on endomyocardial biopsy in HIV-infected patients is most often nonspecific and manifested as focal, inflammatory lymphocytic infiltrates without myocyte necrosis.…”

“…Toxoplasma gondii is the most frequently documented infectious cause of myocarditis associated with AIDS. Myocardial toxoplasmosis described in 1 to 16 percent autopsy series of patients dying of AIDS (Anderson et al, 1988;Baroldi et al, 1988;Matturri et al, 1990). Cytomegalovirus is another common opportunistic infection in patients with late stage AIDS that can cause myocarditis in selected patients Niedt & Schinella, 1985).…”