Figure 1

Cardiac magnetic resonance and left ventricular endomyocardial biopsy before (upper panels) and after recovery from autoimmune myocarditis (lower panels) in HIV- infected patient. Long axis images (panel A = diastole, panel B = systole) show a severe dilated and dysfunctional left ventricle recovering (ejection fraction from 20 to 45%) after 4 months of steroid treatment (panel G = diastole, panel H = systole). T2 short-tau inversion recovery images (T2-STIR) in mid ventricular short axis show subepicardial edematous imbibition of the infero-lateral segment of the left ventricular myocardium (panel C, arrows), and thickening of pericardial layers with minimal amount of effusion (panel C, arrowheads) corresponding to late gadolinium enhancement (LGE) with the same distribution (panel D, arrows). At 4-month follow up T2w-STIR e LGE images (panel I and L) show complete regression of tissue edema and late enhancement. Severe lymphocytic myocarditis (panel E, H&E, 200x) with overexpression of HLA-DR on cardiomyocyte membrane (arrow in panel F, immunoperoxidase, 400x) and positivity of cardiac serum to antiheart autoantibodies (panel F insert) resulted in healed myocarditis with disappearance of inflammatory infiltrates (panel M, H&E, 200x) and interstitial and focal replacement fibrosis (panel N, Masson’s trichrome, 200x).