Correct!
2. Cardiac MR shows inflammatory change suggesting myocarditis
Cardiac MR shows findings suggestive of inflammatory myocardial disease, including extensive diffuse subendocardial edema with abnormal perfusion. The abnormal findings do not conform to a vascular territory and therefore do not suggest an ischemic etiology. No cardiac mass is seen. No evidence of pericardial inflammatory disease is present.
The pattern of abnormality at cardiac MR combined with hypereosinophilia lead to the diagnosis of eosinophilic endomyocarditis. The patient’s history of relative pancytopenia prompted an oncology consult, which recommended a bone marrow biopsy, which showed no evidence of Myelodysplastic Syndrome Fluorescent In Situ Hybridization (MDS FISH) or other abnormal mutations, normal trilineage cellularity, and 43% eosinophils.( Infectious disease was consulted and recommended testing for parasitic disease, and the patient did report travel from Fiji to Hawaii as well as to Connecticut fairly recently. Troponin levels continued to trend upward (0.124 → 0.221 → 0.424 → 0.570, ng/mL (normal, ≤0.01 ng/mL), and high-dose prednisone therapy was begun.
Which of the following represents an appropriate consideration for the differential diagnoses of this patient? (Click on the correct answer to be directed to the 7th of 17 pages)