case_images: PMC3895747_01
case_images: Electrocardiography on admission. Electrocardiography showed atrial fibrillation and an accelerated idioventricular rhythm (62 beats/min), suggesting complete atrioventricular block.
case_images: 1743-422X-11-3-1.jpg
case_images: PMC3895747_01_1743-422X-11-3-1.jpg
case_images: F1
case_images: Electrocardiography showed atrial fibrillation and an accelerated idioventricular rhythm, suggesting complete atrioventricular block (Figure 1).
case_images: Clinical course of the patient after admission. Levels of serum aspartate aminotransferase (AST; diamonds), alanine aminotransferase (ALT; squares), and creatinine phosphokinase (CPK; triangles) were high. The AST level peaked on day 2, ALT on day 3, and CPK on day 4. The levels of brain natriuretic peptide (BNP) and troponin I (TnI) were highest at admission and subsequently decreased, but did not return to normal. The gamma-glutamyl transpeptidase (gamma-GTP) level was moderately elevated during hospitalization. The serum creatinine level returned to normal by day 7.
case_images: 1743-422X-11-3-2.jpg
case_images: PMC3895747_01_1743-422X-11-3-2.jpg
case_images: F2
case_images: His aspartate aminotransferase (AST) level peaked on day 2 (7752 IU/L) and his alanine aminotransferase (ALT) level peaked on day 3 (5899 IU/L) (Figure 2).
case_images: Abdominal computed tomography (CT) on day 5. Abdominal CT to investigate the cause of epigastric pain showed localized swelling of the pancreatic body and tail, with no cholelithiasis or tumor obstructing the common bile duct or pancreatic duct, suggesting idiopathic pancreatitis.
case_images: 1743-422X-11-3-3.jpg
case_images: PMC3895747_01_1743-422X-11-3-3.jpg
case_images: F3
case_images: Abdominal computed tomography showed swelling of the pancreatic body and tail, with increased retroperitoneal adipose-tissue density, suggesting pancreatitis (Figure 3).
case_images: Histopathological examination of a biopsy specimen from the left ventricle. Low-power view (x 100) (A) and high-power view (x 400) (B) of the biopsy specimen obtained from the left ventricle, stained with hematoxylin and eosin, showing lymphocytic infiltration into the interstitium and mild necrosis of the myocardium. Immunohistochemical staining with anti-CD3 (C) and anti-CD20 antibodies (D). CD3-positive lymphocytes were predominant.
case_images: 1743-422X-11-3-4.jpg
case_images: PMC3895747_01_1743-422X-11-3-4.jpg
case_images: F4
case_images: A pathological examination of an EMB specimen of the left ventricle showed necrotic cardiomyocytes adjacent to areas with interstitial infiltration of CD3-positive lymphocytes (Figure 4A-D), confirming acute myocarditis.