Quick Fire Cases
Thomas T. Yoo, DO
Resident Physician
Loma Linda University Health Education Consortium
Thomas T. Yoo, DO
Resident Physician
Loma Linda University Health Education Consortium
Shannon Kirk, MD
Radiologist
Loma Linda University Medical Center
Purvi Parwani, MD FSCMR
Associate Professor of Medicine
Loma Linda University Medical Center
A 31-year-old female with history of recent celiac disease diagnosis, unexplained weight loss, and fatigue, presented with palpitations, progressive muscle weakness and fatigue of 6 months. She was found to have elevated high sensitivity troponin T at 256 ng/L (normal < 52 ng/L), 194 ng/L an hour after, and 196 ng/L 3 hours later. Echocardiogram showed frequent ectopic beats noted during exam, with decreased LVEF 40-45%. MRI femur was suggestive of myositis with muscle biopsy showing active inflammatory myopathy. Patient received solumedrol and IVIG then discharged with prednisone. Patient was diagnosed with new onset cardiomyopathy likely due to inflammatory myopathy. She was started on GDMT that she has been noncompliant with since the discharge. Cardiovascular magnetic resonance (CMR) was ordered to further evaluate the cardiac involvement.
Diagnostic Techniques and Their Most Important Findings:
CMR was performed using the Siemens Magnetom Aera 1.5 Tesla MR scanner. Sequences included cine and delayed myocardial enhancement. CMR showed globally enlarged LV, hypokinesis in inferior and lateral walls, subepicardial late gadolinium enhancement (LGE) in the inferolateral wall, and patchy LGE in lateral wall.
Learning Points from this Case:
We report a case of myocarditis likely secondary to ongoing inflammatory myositis. Cardiac involvement in Inflammatory myositis is rare. This case highlights the importance of getting CMR in patients with inflammatory disorder to further evaluate the etiology of heart failure.
