case_images: PMC8133866_01
case_images: EKG performed in the ED showed a heart rate of 74 and a regular sinus rhythm, with no acute disease processes.
case_images: CRIHEM2021-6621007.001.jpg
case_images: PMC8133866_01_CRIHEM2021-6621007.001.jpg
case_images: fig1
case_images: His initial ECG showed no acute changes (Figure 1), and a bedside echocardiogram showed a preserved ejection fraction.
case_images: Bone marrow aspirate smears were significant for approximately 62% myeloblasts, and the background hematopoiesis was markedly decreased.
case_images: CRIHEM2021-6621007.002.jpg
case_images: PMC8133866_01_CRIHEM2021-6621007.002.jpg
case_images: fig2
case_images: Bone marrow aspirate smear is shown in Figure 2.
case_images: Cardiac MRI showed features consistent with myocarditis satisfying the updated Lake Louise criteria, visualized in these images. (a) Mid-short-axis native T1 mapping demonstrated elevated native myocardial T1 at 1173 ms (local lab normal reference: 950-1050 ms). (b) Mid-short-axis T2 mapping demonstrated elevated myocardial T2 at 58 ms (normal reference: 40-50 ms). (c) Mid-short-axis phase-sensitive inversion recovery late gadolinium enhancement image showed multiple areas of subepicardial enhancement in the lateral wall, as well as midmyocardial enhancement in the septum. (d) Four-chamber late gadolinium enhancement image demonstrated midmyocardial enhancement in the septum and subepicardial to midmyocardial enhancement in the lateral wall.
case_images: CRIHEM2021-6621007.003.jpg
case_images: PMC8133866_01_CRIHEM2021-6621007.003.jpg
case_images: fig3
case_images: A dedicated cardiac MRI (Figure 3) demonstrated evidence of nonischaemic myocardial inflammation consistent with myocarditis.
case_images: Skin biopsy showed dense dermal infiltrate of polymorphonuclear cells at both low (a) and high (b) magnification.
case_images: CRIHEM2021-6621007.004.jpg
case_images: PMC8133866_01_CRIHEM2021-6621007.004.jpg
case_images: fig4
case_images: The histologic image of the skin biopsy at both low and high magnification is shown in Figure 4.