Fulminant myocarditis with prolonged active lymphocytic infiltration after hemodynamic recovery

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 with18F-FDG uptake in18F-FDG PET/CT until about 70 days after the onset. Therefore, he underwent immuno-suppressive 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. (Int Heart J 2017; 58: 294-297)