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05 February 2024 : Case report  China (mainland)

[In Press] Lymphocytic Myocarditis with Increased Left Ventricular Thickness: A Rare Presentation Mimicking Cardiac Amyloidosis

Unusual clinical course, Mistake in diagnosis

Xueting Duan1ABCDEF, Liangzhen Qu1AEFG, Han Chen2ABEF

DOI: 10.12659/AJCR.942760

Am J Case Rep In Press; DOI: 10.12659/AJCR.942760  

Available online: 2024-02-05, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Lymphocytic myocarditis is an inflammatory condition of the heart that may present with a wide spectrum of symptoms and signs, ranging from asymptomatic to life-threatening cardiogenic shock and ventricular arrhythmia. Lymphocytic myocarditis usually presents as chamber dilation. However, increased left ventricular thickness is relatively rare. We present a case of lymphocytic myocarditis with increased left ventricular thickness which mimics the presentation of cardiac amyloidosis.
CASE REPORT
An 80-year-old Chinese man presented to the emergency room due to recurrent chest tightness. Wheezing and crackling were heard in both lungs, along with bilateral lower-extremity edema. He had elevated cardiac troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Bedside echocardiogram showed left ventricular diastolic dysfunction and increased left ventricular thickness. Holter monitoring showed paroxysmal atrial fibrillation (AF) and atrial flutter. ⁹⁹ᵐTechnetium-pyrophosphate scintigraphy showed grade 1 myocardial uptake. Endomyocardial biopsy revealed lymphocytic myocarditis. The patient was put on steroids, managed with diuretics to alleviate the symptoms of congestion, and amiodarone for conversion of AF to sinus rhythm. He had no deterioration of cardiac function in the follow-ups, but there was still asymmetric interventricular septal hypertrophy.
CONCLUSIONS
Lymphocytic myocarditis may lead to increased left ventricular thickness in some rare cases. In the setting of unexplained increased left ventricular thickness, one should consider lymphocytic myocarditis as a differential diagnosis. In addition, endomyocardial biopsy should be performed as early as possible to confirm the diagnosis and identify the type of inflammation, which helps with treatment and prognosis.

Keywords: Myocarditis; Hypertrophy, Left Ventricular; Biopsy; Myocardial Perfusion Imaging

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Am J Case Rep In Press; DOI: 10.12659/AJCR.942323  

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Cloacal Dysgenesis Sequence in a Preterm Neonate

Am J Case Rep In Press; DOI: 10.12659/AJCR.942203  

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Am J Case Rep In Press; DOI: 10.12659/AJCR.943407  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923