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A 22-year-old man was seen in the neurology clinic because of an unexplained creatine kinase elevation.
He had been well until the age of 17 years, when congestive heart failure developed; microscopical examination of a specimen from a left ventricular endomyocardial biopsy revealed myocarditis (Figure 1). Immunosuppressive therapy, digoxin, and diuretic and vasodilator medications caused no improvement in the patient's condition. One year later, the heart failure had worsened, and during the next 20 months, a series of left ventricular–biopsy specimens showed healed myocarditis, with focal fibrosis and hypertrophy (Figure 2). An orthotopic cardiac transplantation was
Differential Diagnosis
Clinical Diagnosis
Dr. H. Royden Jones, Jr.'s Diagnosis
Pathological Discussion
Anatomical Diagnosis
References
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