Association of Drowning and Myocarditis in a Pediatric Population: An Autopsy-Based Study

Abstract

Abstract Context.—Drowning is a frequent cause of accidental death in childhood, but the association of myocarditis and drowning has only rarely been reported. Objective.—To report 5 cases of drowning in children with coexistent myocarditis. Design.—A retrospective review of autopsy records of patients 0 years to 18 years of age was performed during a 6-year period (1998–2003, total cases reviewed = 1431). Results.—Twenty-two drownings were identified, in 14 male and 8 female children. Five patients (23%), 3 female and 2 male children, had coexistent myocarditis. The 5 patients ranged in age from 23 months to 13 years (mean, 7 years 2 months). None of the patients had antecedent symptomatology suggestive of myocarditis. In all patients, the myocarditis was focal mild or moderate, and the inflammatory infiltrate comprised lymphocytes with smaller numbers of neutrophils. All 5 patients had foci of myocyte necrosis. One patient had histologic evidence of myocardial hypertrophy but no evidence of a cardiomyopathy. Microbiologic studies, including culture, immunohistochemistry, polymerase chain reaction, and reverse transcriptase polymerase chain reaction, revealed Mycoplasma pneumoniae DNA in 1 case. Conclusions.—The finding of myocarditis in a significant proportion of drowning victims in this series highlights the importance of a thorough autopsy examination in apparently straightforward cases and has clinicopathologic significance.