A 20-YEAR-OLD MAN who was a college baseball player in excellent health complained of back pain and malaise. His symptoms became progressively worse despite being prescribed several medications. Nausea, bloody diarrhea, submandibular lymphadenopathy, hemoptysis, blurred vision, and dizziness developed. On presentation to an emergency department, the results of laboratory studies showed marked leukocytosis and disseminated intravascular coagulation. The patient was transferred to a university hospital, where the possibility of an unusual viral illness was considered. He appeared stable on admission to the hospital but suddenly became unresponsive and apneic 4 hours later. A cardiac monitor indicated electromechanical dissociation, and the advanced cardiac life support protocol was unsuccessful. An autopsy was requested by the physician primarily to identify the etiologic agent of the presumed fatal viral illness.
Major autopsy findings included severe hypersensitivity myocarditis, acute respiratory disease syndrome, interstitial nephritis, and centrilobular hepatic necrosis. All the organs examined showed