Extract

A 32-year-old male was admitted into the hospital due to acute heart failure. He had a recently diagnosed HIV infection with high viral load, primary haemophagocytic syndrome under immunosuppressive therapy, and CMV infection. Cardiac biomarkers were increased (high-sensitive T-Troponin 1350ng/L; NTproBNP 21.000 ng/L). The 2D-echocardiogram showed global hypokinaesia and depressed left ventricular ejection fraction (LVEF). A computed tomography (CT) observed normal heart density (Panel A). Cardiac magnetic resonance (CMR) showed mid-wall late gadolinium enhancement (LGE) at the mid-distal interventricular septum (PanelsB and C); thus, acute myocarditis was diagnosed. At discharge, full recovery of LVEF was confirmed.

Two months later, due to a cryptogenic organizing pneumonia, a new CT demonstrated an extensive myocardial calcification in the mid-distal septum (Panel D), correlating with the area of LGE in CMR. A new CMR revealed persistence of LGE without myocardial oedema in T2-Stir sequences (Panel E). Transthoracic echocardiogram confirmed the appearance of a septal hyperintensity in the mentioned location (Panel F) and normal LVEF.

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