Fulminant Myocarditis With Prolonged Active Lymphocytic Infiltration After Hemodynamic Recovery

• Published in: International Heart Journal Vol. 58; no. 2; pp. 294 - 297
• Main Authors: Tanimura, Muneyoshi, Dohi, Kaoru, Imanaka-Yoshida, Kyoko, Omori, Taku, Moriwaki, Keishi, Nakamori, Shiro, Yamada, Norikazu, Ito, Masaaki
• Format: Journal Article
• Language: English
• Published: Japan International Heart Journal Association 2017; Japan Science and Technology Agency
• Subjects: 18F-FDG PET/CT; Chronic myocarditis; Electrocardiography; Endomyocardial biopsy; Heart; Heart diseases; Hemodynamics; Humans; Immunosuppressive agents; Lymphocytes; Male; Middle Aged; Myocarditis; Myocarditis - immunology; Oxygenation; Positron emission tomography; Ventricle
• ISSN: 1349-2365; 1349-3299
• DOI: 10.1536/ihj.16-225

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.