PMC9664397_01
Cardiac MRI (CMR) late gadolinium images, short axis view (A, B), 4-chamber view (C) and 3-chamber view (D). Patchy mid-wall to near transmural LV myocardial late gadolinium enhancement (LGE) is present throughout the myocardium suggesting infiltrative pattern (arrow).
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CMR shows diffuse mid-wall to near transmural left ventricular (LV) patchy enhancement throughout the myocardium suggesting an infiltrative pattern (Fig. 1).
A) Low magnification image of the biopsy shows a diffuse inflammatory infiltrate throughout the myocardium. Scale bar = 150 micrometer. (B) Higher magnification image shows the infiltrate is eosinophil rich and also contains lymphocytes, plasma cells and histiocytes. Foci of myocyte injury and dropout are easily appreciated. Scale bar = 50 micrometer. (C) CD3 immunostain highlights the infiltrating T-cells. Scale bar = 100 micrometer. (D) No giant cells per se are seen in the infiltrate. But CD68 immunostain highlights the numerous histiocytes. Scale bar = 100 micrometer.
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Right heart catheterization was performed for endomyocardial biopsy which showed acute myocarditis with an eosinophil rich infiltrate (Fig. 2), confirming the diagnosis.