title: Lymphocytic myocarditis presenting as nausea, vomiting, and hepatic dysfunction in the first trimester of pregnancy.
abstract: BACKGROUND
  Lymphocytic myocarditis, an immune disorder of left ventricular dysfunction with sometimes confounding clinical presentations, occurs rarely during pregnancy.
  
  
  METHODS
  At 12 weeks gestation, a multigravid patient presented with a 2-month history of nausea and vomiting. Other symptomatology included postprandial epigastric pain, loose stools, and a 10-lb (4.5-kg) weight loss. Laboratory evaluation revealed evidence of hepatic dysfunction with a coagulopathy and an absolute unconjugated hyperbilirubinemia. While undergoing evaluation, the patient deteriorated rapidly and suffered a cardiopulmonary arrest. Autopsy revealed a congested liver and spleen associated with a dilated cardiomyopathy and lymphocytic myocarditis.
  
  
  CONCLUSIONS
  Medically virulent disease processes can mimic the common pregnancy complaint of nausea and vomiting. Intrinsic cardiac disease with secondary hepatic compromise is a rare cause of gastrointestinal symptomatology early in pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA.
authors.forename: Robert Clifton
authors.initials: RC
authors.lastname: Moore
authors.forename: Christian M
authors.initials: CM
authors.lastname: Briery
authors.forename: Carl H
authors.initials: CH
authors.lastname: Rose
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Skelton
authors.forename: James N
authors.initials: JN
authors.lastname: Martin
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology*; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D009325:Nausea; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis*; D011261:Pregnancy Trimester, First; D014839:Vomiting
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase