An autopsy case of necrotizing eosinophilic myocarditis causing left ventricular wall rupture

Acute necrotizing eosinophilic myocarditis (ANEM) is a rare entity with sudden onset and rapidly progressive course, usually leading to a fatal outcome. It is characterized by focal or widespread myocyte necrosis. The entity’s clinical presentation is quite variable, rendering the antemortem diagnosis difficult. A case of a 66-year-old woman dying suddenly, initially considered to have suffered a myocardial infarction and finally proved at autopsy to have died due to ANEM resulting in myocardial rupture, is presented. Left ventricular wall rupture is in the majority of cases, a complication of myocardial infarction and its association with acute myocarditis has been very rarely reported. The case reported herein highlights the infrequent presentation of ANEM as cardiac rupture. Myocardial rupture is associated with a high mortality rate, even if immediate surgical repair and intervention are provided.