PMC10310455_01
Electrocardiogram demonstrating atrial tachycardia with 127 beats per minute and a right bundle branch block configuration.
CRIC2023-7646962.001.jpg
PMC10310455_01_CRIC2023-7646962.001.jpg
fig1
Electrocardiogram showed an atrial tachycardia and a right bundle branch block (Figure 1).
Transthoracic echocardiography showing four chamber cardiac view.
CRIC2023-7646962.002.jpg
PMC10310455_01_CRIC2023-7646962.002.jpg
fig2
Pericardial effusion could be ruled out as well as a valvular heart disease (Figure 2).
CMR imaging study showing severe LV dysfunction and signs of acute myocarditis. (a and c) Three-chamber views, (b and d) short axis views. (a and b) LGE images with severe subepicardial to transmural LGE inferolateral and anterolateral. (c and d) Native T1-maps with focal increased native T1 values in LGE positive regions.
CRIC2023-7646962.003.jpg
PMC10310455_01_CRIC2023-7646962.003.jpg
fig3
Additionally, enlarged mediastinal and hilar lymph nodes could be detected and a minimal left sided pericardial effusion (Figures 3(a), 3(b), 3(c), and 3(d)).
Histopathological images. (a) Histological findings in the endomyocardial biopsy showing active lymphocytic myocarditis with necrosis and areas of organization (Giemsa), (b) CD3 and T-cells, and (c) CD 68 and macrophages.
CRIC2023-7646962.004.jpg
PMC10310455_01_CRIC2023-7646962.004.jpg
fig4
Histology and immunohistology of the EMB revealed an acute lymphocytic myocarditis with focal myocyte necrosis and infiltration of CD3+ T cells and CD68+ macrophages on day 13 (Figures 4(a), 4(b), and 4(c)).
Electrocardiogram demonstrating non-sustained ventricular tachycardia and frequent premature ventricular complexes.
CRIC2023-7646962.005.jpg
PMC10310455_01_CRIC2023-7646962.005.jpg
fig5
On day 17, a non-sustained ventricular tachycardia was documented (Figure 5).