Fulminant Myocarditis With Prolonged Active Lymphocytic Infiltration After Hemodynamic Recovery.
Fulminant myocarditis is a highly mortal syndrome. Meanwhile, the clinical course in surviving patients is generally self-limiting. This is a rare case of fulminant myocarditis with prolonged lymphocytic infiltration after hemodynamic recovery. A 64-year-old man was diagnosed with fulminant myocarditis and required intensive care with veno-arterial extracorporeal membrane oxygenation. Left ventricular function gradually improved but complete atrioventricular block (CAVB) persisted. Follow-up endomyocardial biopsies (EMBs) showed prolonged active infiltration of lymphocytes along with18F-FDG uptake in18F-FDG PET/CT until about 70 days after the onset. Therefore, he underwent immunosuppressive therapy for 3 months. Follow-up EMB revealed no evidence of infiltration of lymphocytes and no abnormal18F-FDG uptake despite irreversible CAVB. Although repeated EMB and18F-FDG PET/CT was not a standard strategy, it played an important role in the treatment decision in the present case.
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine.
Muneyoshi
M
Tanimura
Kaoru
K
Dohi
Kyoko
K
Imanaka-Yoshida
Taku
T
Omori
Keishi
K
Moriwaki
Shiro
S
Nakamori
Norikazu
N
Yamada
Masaaki
M
Ito
D006439:Hemodynamics; D006801:Humans; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000276:immunology*