title: A Case of Fulminant Myocarditis With Preceding Repeated Episodes of Congestive Heart Failure.
abstract: We report a rare case of fulminant myocarditis that was considered to have smoldered for a few months before it finally exteriorized. An 80-year-old man had had two episodes of mild congestive heart failure with preserved ejection function (HFPEF) within 3 months before he was finally admitted for the treatment of rapidly progressive heart failure. Cardiac function deteriorated remarkably on the final admission. Extracorporeal cardiopulmonary support was used because of pump failure and conduction disability, however, the patient died on the 16th day. Endomyocardial biopsy revealed numerous inflammatory infiltrates in myocardium compatible with fulminant myocarditis. However, advanced fibrosis and increased number of B lymphocytes and plasma cells found in the present case were not typical for fulminant myocarditis. Considering several distinctive findings in clinical and laboratory findings together, two preceding HFPEF episodes were highly likely to be associated with myocarditis.
authors.affiliation: Division of Cardiovascular Medicine, The University of Tokyo, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Tada
authors.affiliation: Department of Pathology, Tokyo Women's Medical University, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Uto
authors.affiliation: Department of Cardiovascular Medicine, Saitama Medical Center, Jichi-Medical University, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.affiliation: Department of Cardiovascular Medicine, Saitama Medical Center, Jichi-Medical University, Japan.
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Sakakura
authors.affiliation: Department of Advanced Clinical Science and Therapeutics, University of Tokyo, Japan.
authors.forename: Jun-Ichi
authors.initials: JI
authors.lastname: Suzuki
authors.affiliation: Department of Surgical Pathology, Tokyo Women's Medical University, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Nishikawa
authors.affiliation: Department of Cardiovascular Medicine, Saitama Medical Center, Jichi-Medical University, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Ako
authors.affiliation: Department of Cardiovascular Medicine, Saitama Medical Center, Jichi-Medical University, Japan.
authors.forename: Shin-Ichi
authors.initials: SI
authors.lastname: Momomura
keywords: Episode; Heart failure; Myocarditis