case_images: PMC11405220_01
case_images: Late gadolinium enhancement (LGE) findings from previous follow-up, admission, and post-discharge follow-up. (A) LGE of the left ventricular (LV) lateral wall in August 2020 (LV short-axis views). (B) LGE of the LV lateral wall in August 2020 (LV long-axis views). (C) LGE of the LV lateral wall from the basal to middle segments in January 2023 (LV short-axis views). (D) LGE of the LV lateral wall from the basal to middle segments in January 2023 (LV long-axis views). (E) LGE was present in the interventricular septum and inferolateral lateral walls (blue arrowheads) at admission (LV short-axis views). (F) Progression of LGE in the inferolateral walls at admission (LV long-axis views). (G) LGE persisted in the interventricular septum and inferolateral lateral walls in July 2024 (LV short-axis views). (H) An increased extent of LGE was evident in the inferolateral walls (yellow arrowhead) in July 2024 (LV long-axis views).
case_images: fcvm-11-1419496-g001.jpg
case_images: PMC11405220_01_fcvm-11-1419496-g001.jpg
case_images: F1
case_images: At the time of presentation to our hospital, the patient had a 3-year history of suspected DMD-associated cardiomyopathy, based on the presence of late gadolinium enhancement (LGE) in the left ventricular lateral wall on screening cardiac magnetic resonance imaging (CMR) (Figures 1A-D). Additionally, LGE progression in the inferolateral walls and interventricular septum was observed, supporting a diagnosis of acute myocarditis (Figures 1E,F). T2 mapping, 42.0 +- 0.9 ms) (Figures 3C,D) but revealed an increased range of LGE in the lateral walls of the basal segment (Figures 1G,H).
case_images: (A) Electrocardiogram at admission in October 2023 showing mild ST elevations and an abnormal Q wave in leads II, III, and aVF. (B) Follow-up electrocardiogram after improvement of myocarditis in February 2024 showing abnormal Q waves and T-wave flattening or inversion in leads II, III, and aVF.
case_images: fcvm-11-1419496-g002.jpg
case_images: PMC11405220_01_fcvm-11-1419496-g002.jpg
case_images: F2
case_images: An electrocardiogram (ECG) revealed slight ST elevation and abnormal Q waves in the inferior wall (Figure 2A). After improvement of myocarditis, an ECG showed abnormal Q waves and T-wave changes in leads II, III, and aVF (Figure 2B).
case_images: T2-weighted imaging and T2 mapping images at admission and follow-up. (A) At admission, T2-weighted imaging showed localized high signals in the left ventricular septum, lateral wall, and inferior wall (yellow arrowheads). (B) At admission, T2 mapping images showed abnormally elevated T2 values (mean value = 56.9 ms) in the basal to middle segments of the interventricular septum and inferolateral walls. (C) During the follow-up cardiac magnetic resonance examination in July 2024, T2-weighted imaging showed no signs of myocardial edema. (D) During the follow-up cardiac magnetic resonance examination in July 2024, T2 mapping images showed reduced T2 values (mean value = 42.0 ms) in the basal to middle septal and inferolateral walls.
case_images: fcvm-11-1419496-g003.jpg
case_images: PMC11405220_01_fcvm-11-1419496-g003.jpg
case_images: F3
case_images: CMR examination was recommended. CMR showed inflammatory myocardial edema with localized T2 hyperintensity (T2 ratio, 2.4; T2 mapping, 56.9 +- 0.4 ms) in the inferolateral walls and interventricular septum from the basal to middle segments (Figures 3A,B). T2 mapping, 42.0 +- 0.9 ms) (Figures 3C,D) but revealed an increased range of LGE in the lateral walls of the basal segment (Figures 1G,H).
case_images: (A) Changes in the patient's cardiac troponin I (cTnI) levels over time. (B) Timeline of the patient's diagnosis and treatments.
case_images: fcvm-11-1419496-g004.jpg
case_images: PMC11405220_01_fcvm-11-1419496-g004.jpg
case_images: F4
case_images: An outpatient follow-up examination after about 110 days revealed that the patient's cTnI levels had returned to baseline (Figure 4A). The patient is currently asymptomatic and continues to undergo monitoring via outpatient and telephone follow-up. The patient's timeline is summarized in Figure 4B.