Sudden infant death due to Lactococcal infective endocarditis.

Infective endocarditis (IE) of infants is rare, most of which occur associated with congenital heart disease or its cardiac surgery. We experienced a case of sudden death of a four-month-old male infant without congenital heart disease. It was elucidated by postmortem examination that the dead had suffered severe IE, which led him to death. In the microbiological genetic analysis using histological section, the pathogen causing inflammation in the present case was identified as Lactococcus lactis subspecies, although Staphylococci have been reported to be common and important one. Previously reported infectious diseases by Lactococcus lactis subspecies were all adult cases and this is the first report of an infantile death due to Lactococcal IE according to our knowledge. Any fatal disease may be included in sudden death cases targeted for forensic autopsy, even if it is rare. It is expected for forensic pathologists that they note such case and share each experience among themselves and other medical fields to develop a strategy for prevention.

[Acute congestive heart failure due to malignant rheumatoid arthritis].

A 54-year-old woman with malignant rheumatoid arthritis was admitted with acute congestive heart failure and pulmonary hypertension. The precipitating antibody to nuclear ribonucleoprotein (nRNP) was highly positive. Her hands and feet showed typical rheumatoid deformities and Raynaud's phenomenon. In a few days her feet became to necrosis due to vasculitis. "Pulse" methylprednisolone and prednisone therapy resulted in normalization of seropositivity, and left ventricular ejection fraction with symptoms of congestive heart failure, and the elimination of ECG abnormalities. Recognition of symptoms of left ventricular dysfunction in patients with rheumatoid arthritis should prompt testing for active arteritis and/or myocarditis, because dramatic improvement may result from immunosuppressive therapy.