An autopsy case of myocarditis complicated with disseminated intravascular coagulation

Disseminated intravascular coagulation (DIC) occurs in various pathological conditions such as malignant tumor, leukemia, shock, and severe infections, particularily in gram negative sepsis. Recently, DIC associated with viral, rickettsial, and mycoplasmal infection has been reported. In this paper, a case of myocarditis complicated with DIC is reported.A 41 year old female had felt cold accompanied with coughing, fever, palpitation and general malaise since 10 days prior to admission. On admission, a chest X-ray film showed marked cardiac enlargement with pleural effusion in both sides. ECG revealed low voltage, complete left bundle branch block and ST-elevation in I and aVL leads. Serum GOT, GPT, CPK, and LDH elevated up to 196, 201, 417, and 2000, respectively. Blood pressure was 88/60mmHg, venous pressure 20mm H2O. The patient was suspected to have congestive heart failure due to myocarditis, and was given diuretics and digitalis. On the 3rd hospital day, oliguria, marked thrombocytopenia, lowered fibrinogen level as well as an elevation of fibrinogen degradation product developed suddenly, suggesting DIC complication.Despite administration of heparin, her condition did not improve, and died on the 13th hospital day.An autopsy indicated an evidence of scattered myocardial necrosis with massive hemorrhage, and fibrosis with plasma cell infiltrations in the myocardium. There were an evidence of thrombus formation in the microvasculature of the kidneys and in the sinusoid of the liver, and also severe diffuse bilateral cortical necrosis of the kidneys. DIC was a major factor in the genesis of acute renal failure. In this case, bilateral renal cortical necrosis was thought to be due to DIC, as reported already, and acute renal failure and DIC were considered to be due to myocarditis.