ABSTRACT
A transthoracic echocardiogram showed normal chamber sizes, an estimated left ventricular ejection fraction of 60%, trace mitral regurgitation, trace tricuspid regurgitation, and no pericardial effusion. The patient was treated with a single 2-g/kg dose of intravenous immunoglobulin and started on ramipril (10 mg/day). The hitherto described 37-year old woman had a 6-week illness characterized by diarrhea, myalgias, nausea and vomiting, palpitations, runs of ventricular tachycardia, marked elevation of certain hepatic enzymes, extreme low voltage on the electrocardiogram, and ending by sudden death while sleeping. Although hepatic enzyme determinations were not reported in the previously described necropsy patients with fatal lymphocytic myocarditis until the present report, elevated serum creatinine phosphokinase and the MB fraction have been described in several live patients with biopsy-proved lymphocytic myocarditis. An unexpected finding in our patient was the extreme low voltage on the electrocardiogram in the absence of evidence of pericardial effusion.
