Viral myocarditis in a patient following allogenic stem cell transplant: Diagnostic dilemma and management considerations

Establishing aetiology of myocarditis is important in order to irect management strategies appropriately. In presence of muliple risk factors and co-morbidities definitive diagnosis is often ifficult if not impossible. We report an unusual post-transplant omplication in a 54-year-old female who received single antigen ismatch, reduced intensity, unrelated donor stem cell transplant or acute myeloid leukaemia. Alemtuzumab was incorporated into he conditioning regimen. On day +12 post-transplant she develped profuse diarrhoea and vomiting with isolation of adenovirus rom blood and faeces samples as well as nose and throat swabs. iral DNA load in blood peaked at 8.2 million copies/mL. There as good response to treatment with cidofovir (5mg/kg/week for weeks) with resolution of the viraemia. Four months post-transplant she was admitted with short hisory of severe shortness of breath and worsening orthopnea with istory of coryzal symptoms and sore throat 2 weeks back. She ad tachycardia, tachypnea and hypoxia. CT scan of chest revealed ilateral pleural effusions, ECG showed sinus tachycardiawith nonpecific ST-T changes and an echocardiogram confirmed markedly ilated, hypokinetic ventricleswith poor LV ejection fraction of 17%. diagnosis of myocarditis/dilated cardiomyopathy with conges-