Case of Myocardial Relapse of a T-Cell Lymphoma After Hematopoietic Stem Cell Transplantation Demonstrated by Cardiovascular Magnetic Resonance and Endomyocardial Biopsy

Abstract

A 23-year-old patient with recent history of hematopoietic stem cell transplantation as a result of a relapse of a cortical T-cell lymphoma presented with dyspnea and recurrent nightly tachycardia. The initial ECG showed ST-segment depression in leads I and II and over the anterior wall, as well as tachycardia (heart rate, 110 bpm; Figure 1). The troponin test was positive (1.780 μg/L; normal, <0.014 μg/L). Transthoracic echocardiography showed uniform thickening of the left ventricular wall with global hypokinesia and a moderate pericardial effusion without cardiac tamponade (Movie I in the online-only Data Supplement). Figure 1. The patient’s ECG at initial presentation: sinus rhythm; heart rate, 73 bpm; normal QRS axis; PQ, 160 milliseconds; broadened QRS complexes (120 milliseconds) with right bundle-branch (rsR′) morphology in V1 and V2; and ST-segment depression with pronounced T-wave inversion in the left precordial leads. Prolonged corrected QT interval (Bazett)=510 milliseconds. For further diagnostic workup, cardiac magnetic resonance imaging was performed with a clinical 1.5-T scanner (Achieva, Philips Medical Systems, Best, The Netherlands). Functional assessment showed a globally reduced left ventricular ejection fraction of 30% (Movie II in the online-only …