1) and strong reactivity for serum amyloid A (SAA) that possibly explains the discrepancy between mild hypertension and the markedly increased septum thickness. Our second major histological finding was a strong interstitial and vascular deposition of amyloid in the myocardium with typical birefringence (Fig.
#Zebra 2 vs serum series
The highest Troponin T level in their series was 8820 ng/L, somewhat lower than in our patient. found that Troponin T was more sensitive than CK and CK-MB in myocarditis. Could myocarditis explain such a high troponin T level? Lauer et al. High-dose steroids administered shortly after admission possibly contributed to CMV reactivation in our patient. A recent review described only 7 CMV myocarditis cases after solid-organ transplantation. Our patient had an unusual disease course in that CMV disease occurred 13 years after his second transplantation with a rather uncommon organ manifestation, namely myocarditis. With current prophylactic and preemptive antiviral treatment strategies, CMV disease occurs in approximately 15–30% of kidney allograft recipients at high risk within the first year after transplantation. Subsequently, we amplified CMV DNA from plasma, and detected CMV IgM and IgG antibodies indicating CMV reactivation or reinfection. Endomyocardial biopsies established lymphocytic myocarditis, and a nested PCR detected human CMV DNA in the biopsy material confirmed by direct sequencing. We excluded coronary artery occlusion via cardiac catheterization and considered the possibility of storage disease given the 18 mm interventricular septum with only mild hypertension. In contrast, elucidating the cause of the massive troponinemia indicating cardiac muscle breakdown was challenging but also educating education. Inflammatory myositis was ruled out in the muscle biopsy and toxic rhabdomyolysis was assumed, most likely from interactions between CyA and the statin.
![zebra 2 vs serum zebra 2 vs serum](https://images.equipboard.com/uploads/item/image/77018/u-he-hive-2-xl.jpg)
Establishing the underlying cause for the skeletal myocyte damage was rather straightforward.
![zebra 2 vs serum zebra 2 vs serum](https://vi-control.net/community/data/avatars/l/12/12933.jpg)
The patient recovered from rhabdomyolysis only to subsequently develop cardiac muscle lysis.
![zebra 2 vs serum zebra 2 vs serum](https://www.arsov.net/SoundBytes/Images/2019-01/AoP8-02_03_Composite.jpg)
What is the cause of this patient’s tremendous troponinemia? What are your diagnostic tests to establish a diagnosis? Echocardiography revealed an 18 mm septum without regional wall kinetic abnormalities and preserved ejection fraction. The patient did not have angina or ST-elevations in his electrocardiogram. The patient’s electrocardiogram did not show angina or ST-elevations. Creatinine 3.3 mg/dL (Baseline 1.7 mg/dL).ĬK 77,000 U/L (with 10,000 ng/L with only slightly elevated CK (237 U/L, 23% MB) and normal GOT and GPT.