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An infant with dilated cardiomyopathy confirmed as myocarditis by endomyocardial biopsy
T Nishikawa1, M Sekiguchi, Y Kunimine
1Heart Institute of Japan, Tokyo Women's Medical College.
Insights
This report details the youngest infant diagnosed with myocarditis via endomyocardial biopsy, initially presenting with heart failure and initially misdiagnosed as dilated cardiomyopathy. Biopsy confirmed inflammatory myocarditis, highlighting diagnostic challenges in infants.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Pathology
Background:
- Infantile heart failure often presents diagnostic challenges.
- Dilated cardiomyopathy is a common initial diagnosis in infants with heart failure.
- Myocarditis can mimic other cardiac conditions in pediatric patients.
Observation:
- An 11-month-old infant presented with heart failure, cardiomegaly, and abnormal electrocardiogram findings.
- Echocardiogram revealed a dilated left ventricle with reduced ejection fraction, suggesting dilated cardiomyopathy.
- Endomyocardial biopsy demonstrated massive inflammatory cell infiltration and myocyte degeneration.
Findings:
- The biopsy findings confirmed myocarditis, contradicting the initial diagnosis of dilated cardiomyopathy.
- This case represents the youngest patient diagnosed with myocarditis through endomyocardial biopsy.
- Absence of preceding viral infection or inflammatory markers complicated the initial diagnosis.
Implications:
- Highlights the importance of endomyocardial biopsy in diagnosing pediatric myocarditis, even in the absence of typical triggers.
- Underscores the potential for myocarditis to present atypically in infants.
- Emphasizes the need for considering inflammatory etiologies in infantile heart failure.
Abstract:
A case of an 11-month-old infant who was incidentally diagnosed as having myocarditis by right and left ventricular endomyocardial biopsy is reported. This patient was admitted because of heart failure. Chest X-ray showed cardiomegaly and an electrocardiogram revealed decreased voltage with right atrial and right ventricular overloading. A dilated left ventricle with poor ejection fraction was shown in an echocardiogram. Dilated cardiomyopathy was the initial diagnosis since there was no episode of preceding viral infection or evidence of an inflammatory process in routine laboratory investigations. However, the biopsy findings, including massive infiltration of inflammatory cells and myocyte degeneration, indicated myocarditis. To our knowledge, this is the youngest patient in whom myocarditis has been confirmed by endomyocardial biopsy.