Missed Diagnosis of Lymphocytic Myocarditis Leads to an Untimely Death

Case Overview

This case involves a patient who presented to her PCP with complaints of shortness of breath and asthma-like symptoms. The PCP treated the patient with antibiotics, asthma medications, and sent the patient home. The very next day the patient returned with the same symptoms but the condition was increasing in severity. The physician tried treating the asthma symptoms in his office for several hours until he finally sent her to the ER. The patient was admitted to the emergency room at which point the condition deteriorated and necessitated a transfer to a children’s hospital. The patient died while in transport and the autopsy revealed the cause of death to be Lymphocytic Myocarditis.

Questions to the Pediatrics expert and their responses

Was it reasonable for the PCP to attempt to treat the patient in his office?

It is possible that this started out as a viral respiratory infection, but the doctor should have realized that if the patient wasn't improving with asthma treatment he should have sent her to the ER sooner. In general, if a patient requires 2-3 hours of treatment for 'asthma' they are too sick to be in an office setting and require immediate transfer to a hospital. It's absolutely possible that the 2-3 hours could have made a difference.

About the expert

This expert has nearly 25 years of experience in pediatric cardiology and has presented more than 7 times at regional and national pediatric cardiology society meetings. She has experience both in clinical as well as academic settings and has held positions ranging from attending physician and medical director, to assistant professor. She is a board certified in pediatric cardiology.