Arq. Bras. Cardiol. 2024; 121(8): e20230868

Biventricular Fatal Fulminant Myocarditis Infarct-Like Presentation in a Patient with Thymoma

Fabio Maramao, Fabio Stefano Maramao, Laura Sanchez Monteso, Mirella Marino

DOI: 10.36660/abc.20230868i

Introduction

Thymomas are rare epithelial tumors of the mediastinum frequently associated with paraneoplastic diseases, myocarditis on the other hand is a rare complication in patients affected by thymoma. Polymyositis and myocarditis associated with thymoma are exceptionally rare conditions and are usually accompanied by myasthenia gravis (MG).

Myocarditis, an inflammatory disease of cardiac muscle, may result from a wide variety of infectious, toxic, and autoimmune origins. Although the course of the disease is usually self-limiting, acute, non-fulminant myocarditis may progress to fulminant myocarditis. Non-fulminant myocarditis is typically insidious in presentation and may go unnoticed as it progresses into the chronic phase of the disease. The definition of fulminant myocarditis has evolved since its original description in 1991. In its fulminant form, myocarditis is an illness with hemodynamic derangement and ventricular arrhythmias due to a severe inflammatory process requiring support of cardiac pump function and/or urgent management of serious arrhythmias. Early recognition and aggressive management are essential for a favorable outcome. Acute myocarditis may occasionally have an infarct-like presentation, with chest pain, ST‐segment elevation on electrocardiogram, and elevated troponin levels.

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