Revisiting acute myocarditis in children to save lives 1 MedDocs Publishers Received: Mar 23, 2018 Accepted: Aug 15, 2018 Published Online: Aug 20, 2018 Journal: Annals of Pediatrics Publisher: MedDocs Publishers LLC Online editon: htp://meddocsonline.org/ Copyright: © Bravo-Valenzuela NJM (2018). This Artcle is distributed under the terms of Creatve Commons Atributon 4.0 Internatonal License *Corresponding Author(s): Nathalie JM Bravo-Va- lenzuela Director of Pedicor (Pediatric and Fetal Cardiology Center), Av. Andromeda, 693, s.601-603, Sao Jose dos Campos, SP, 12230-010, Brazil Email: njmbravo@cardiol.br Cite this artcle: Carneiro ÉC, Bravo-Valenzuela NJM, Moura Castro JV. Revisitng acute myocardits in children to save lives. Ann Pediatr. 2018; 2: 1008. Annals of Pediatrics Open Access | Research Artcle Évelin Carvalho Carneiro 1 ; Nathalie JM Bravo-Valenzuela 1,2* ; José Valdez de Moura Castro 2,3 1 Pedicor (Pediatric and Fetal Cardiology Center), Sao Jose dos Campos, SP, Brazil 2 Department of Medicine, Taubate University (UNITAU), Taubate, SP, Brazil 3 Pediatrics, Department of Medicine, Paris University (Sorbonne), Paris, France Abstract Background: A case of sudden unexpected death of an 11-year-old child with tonsillits illustrates acute myocardits and the difculty in diagnosing it. Aims: Consider myocardits among acute pediatric con- ditons, suggestng this disease should be included in the diferental diagnosis for children who are toxemic critcally ill, partcularly when they have respiratory symptoms. Methods: A critcal review of studies published from 1987 to 2018 was conducted. Relevant studies addressed children with deterioraton of a conditon initally con- sidered benign and discussed clinical aspects suggestng various pathologies such that the presence of myocardits was “masked.” Papers on myocardits and sudden death in children were selected by searching electronic databases (Pubmed, Scielo, Semantc Scholar, Google Scholar, Springer Link, Science Direct, NCBI, Research Gate, and others). Art- cles on immunology, pathology, pneumology and radiology were also included that addressed medical reasoning and might assist in early diagnosis. Results: Many cases of myocardits remain undiagnosed due to nonspecifc symptoms. Therefore, the true preva- lence is unknown. The literature reports a high prevalence of histologically proven myocardits on post-mortem exami- naton in pediatric cases of sudden death based on the pres- ence of a lymphocytc infltrate necrosis of myocytes. Conclusion: Early diagnosis and treatment of myocardits might save children who would otherwise die or develop chronic dilated cardiomyopathy. Informaton presented in this review may assist in beter recogniton of this life- threatening disease. Keywords: Myocardits; Diagnosis; Immunology; Sudden death; Childhood Abbreviatons: CMR: Cardiovascular Magnetc Resonance; CRP: C-Reactve Protein; DAD: Difuse Alveolar Damage; DCM: Dilat- ed Cardiomyopathy; DILD: Difuse Intersttal Lung Disease; EF: Ejecton Fracton; ICU: Intensive Care Unit; IVIG: Intravenous Im- munoglobulin; LV: Lef Ventricle; SF: Shortening Fracton; SUDC: Sudden Unexpected Death in Childhood; US: Ultrasound