PMC9772458_01
Timeline presenting the patient's clinical presentation, diagnostic findings, and treatment approach during hospitalization. CMR, cardiac magnetic resonance imaging; CT, computed tomography; ECG, electrocardiogram; hs-cTnT, high sensitive troponin; LVEF, left ventricular ejection fraction; NT pro-BNP, N-terminal pro-brain natriuretic peptide.
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F1
Twelve-days after her first monotherapy treatment with humanized IgG4 anti immunoglobulin-like transcript 3 (ILT3) [MK-0482, MERCK (MSD)] (75 mg), the patient presented to the Hemato-Oncology Ambulatory Care Unit in the Davidoff Cancer Center, Rabin Medical Center (Israel) with fever and malaise (patient's presentation and management time-line is presented in Figure 1).
Magnetic resonance imaging findings: Short axis view (A) of late gadolinium enhancement illustrates sub-epicardial and mid-wall late gadolinium enhancement in the basal infero-lateral and antero-lateral segments (yellow arrows). The corresponding short axis view of T2 mapping (B) illustrates extensive diffuse interstitial myocardial edema (green arrows). Diffuse T2 value was 56.2 ms and focal T2 value in the infero-lateral segment was 61 ms (normal limit 55 ms). The presence of myocardial injury and extensive edema support the diagnosis of acute myocarditis according to the 2018 updated Lake Louise criteria. ms, miliseconds.
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F2
T 224 ng/L and NT pro-BNP 5,815 pg/ml). The diagnosis of acute myocarditis was confirmed using cardiac magnetic resonance imaging (Figure 2) based on the updated Lake Louis criteria demonstrating subepicardial and mid-wall late gadolinium enhancement in the basal infero- and antero-lateral segments with increased values of native T1 time and T2 time revealing extensive diffuse myocardial edema.