Fulminant Myocarditis With Prolonged Active Lymphocytic Infiltration After Hemodynamic Recovery

Int Heart J. 2017 Apr 6;58(2):294-297. doi: 10.1536/ihj.16-225. Epub 2017 Mar 21.

Abstract

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 with 18F-FDG uptake in 18F-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 abnormal 18F-FDG uptake despite irreversible CAVB. Although repeated EMB and 18F-FDG PET/CT was not a standard strategy, it played an important role in the treatment decision in the present case.

Publication types

  • Case Reports

MeSH terms

  • Hemodynamics
  • Humans
  • Lymphocytes*
  • Male
  • Middle Aged
  • Myocarditis / immunology*