Background:
Inflammatory cardiomyopathy is a myocarditis leading to clinical cardiac dysfunction with histopathological manifestations. Here we present an interesting case of a young, healthy male found to have idiopathic cardiomyopathy.
Case:
A 31 year old male with history of autoimmune thyroiditis, ADHD, presented with one week of progressively worsening shortness of breath and orthopnea associated with intermittent episodes of fever and vomiting. On presentation he was hypotensive to 80s/50s and tachycardic to 130s. Labs were remarkable forelevated troponin T at 0.09 and pro-BNP of 30,000. Physical examination revealed bibasilar crackles. Bedside transthoracic echocardiogram (TTE) showed left ventricular ejection fraction (LVEF) of 10-15%. Chest X-Ray was unremarkable. His ESR was 97 and CRP 350. He had three negative COVID-19 tests in the prior week. He was started on a Lasix drip and pressor support. Formal TTE revealed LVEF of 19% and an elevated right atrial filling pressure of 6-10 mmHg.
Decision-making:
Decision was made to transfer the patient to an advanced heart failure and transplant center. He was started on a dobutamine drip enroute. A bilateral heart catheterization revealed normal coronaries and elevated filling pressures. A myocardial biopsy demonstrated lymphohistiocytic myocarditis without giant cells. He had positive Lyme antibody but negative Western blot test, positive rheumatoid factor but negative CCP. Work up for, SARS-CoV-2, HIV, amyloidosis, iron overload or acute thyroid disorders were negative. He recovered with guideline directed medical therapy. Cardiac Magnetic Resonance imaging showed no Late Gadolinium Enhancement and improved LVEF 30%. Repeat TTE three months later revealed a LVEF of 55% with complete symptom resolution.
Conclusion:
Acute heart failure has multiple etiologies with lymphohistiocytic myocarditis being rare. The etiology remained unidentified, after extensive work up was completed. Based on the lymphohistiocytic nature and recent vaccination, the leading diagnosis was thought to be secondary to the mRNA vaccine, which our patient received 21 days prior to his onset of the symptoms.
Footnotes
Poster Contributions
For exact presentation time, refer to the online ACC.22 Program Planner at https://www.abstractsonline.com/pp8/#!/10461
Session Title: Complex Clinical Cases: MD/PhD Flatboard Poster Selections – Heart Failure and Cardiomyopathies
Abstract Category: MD/PhD: Heart Failure and Cardiomyopathies