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Previous Volume 357:2167-2178 November 22, 2007 Number 21 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Presentation of Case

Dr. Jeffrey O. Greenberg (Medicine): A 31-year-old woman was admitted to this hospital because of facial swelling, fever, and hypotension.

The patient had relapsing and remitting multiple sclerosis, associated with severe fatigue. Three weeks before admission, her neurologist prescribed modafinil to treat the fatigue. One week later, periorbital erythema, a clear conjunctival discharge, and a raised erythematous and pruritic rash developed on her face and scalp. She discontinued modafinil and used over-the-counter diphenhydramine, but the rash did not improve. Three days later, she went to the emergency room of a hospital near her home for evaluation. Cyproheptadine was prescribed, but . . . [Full Text of this Article]

Differential Diagnosis

Infectious Myocarditis

Autoimmune Myocarditis

Idiopathic Isolated Giant-Cell Myocarditis

Eosinophilic Cardiomyopathies

Acute Eosinophilic Myocarditis

Acute Necrotizing Eosinophilic Myocarditis

Summary

Dr. Marc S. Sabatine's Diagnosis

Pathological Discussion

Anatomical Diagnosis

Source Information

From the Cardiovascular Division, Brigham and Women's Hospital (M.S.S.); the Cardiology Division (M.S.S., K.-K.P., J.L.M.) and the Departments of Radiology (J.-A.O.S.) and Pathology (J.R.S., M.P.F.), Massachusetts General Hospital; and the Departments of Medicine (M.S.S., K.-K.P., J.L.M.), Radiology (J.-A.O.S.), and Pathology (J.R.S., M.P.F.), Harvard Medical School — all in Boston.

Related Letters:

Case 36-2007: A Woman with Rash, Fever, and Hypotension
Ghei M., Fett J. D., Descamps V., Joly P., Musette P., Mir M. A., Khalil F., Sabatine M. S., Mega J. L., Stone J. R.
Extract | Full Text | PDF  
N Engl J Med 2008; 358:1405-1407, Mar 27, 2008. Correspondence

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• Rogers, J. S., Zakaria, S., Thom, K. A., Flammer, K. M., Kanno, M., Mehra, M. R. (2008). Immune Reconstitution Inflammatory Syndrome and Human Immunodeficiency Virus-Associated Myocarditis. Mayo Clin Proc. 83: 1275-1279 [Abstract] [Full Text]  
• Ghei, M., Fett, J. D., Descamps, V., Joly, P., Musette, P., Mir, M. A., Khalil, F., Sabatine, M. S., Mega, J. L., Stone, J. R. (2008). Case 36-2007: a woman with rash, fever, and hypotension.. NEJM 358: 1405-1406 [Full Text]