A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 28-year-old woman presents with new-onset heart failure symptoms including dyspnea and fatigue. She recently recovered from a viral upper respiratory infection. On examination, she has bilateral pulmonary crackles and an S3 gallop. An echocardiogram reveals an enlarged heart with thin ventricular walls. Which of the following histological findings would most likely confirm the suspected diagnosis?
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A
Giant cell formation with myocardial inflammationIncorrect. Giant cell myocarditis is fulminant and rare; viral post-URI myocarditis features lymphocytic, not giant cell, infiltrate.
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B
Fibrosis with myocyte hypertrophyIncorrect. Fibrosis with myocyte hypertrophy describes hypertrophic or chronic ischemic remodeling, not acute viral myocarditis.
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C
Neutrophilic infiltrates with myocardial necrosisIncorrect. Neutrophilic infiltrates indicate bacterial myocarditis or early ischemic injury, not post-viral inflammation.
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D
Eosinophilic infiltrates with hypersensitivity reactionIncorrect. Eosinophilic infiltrates are seen in hypersensitivity myocarditis or Loffler endocarditis, not post-URI viral.
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E
Lymphocytic infiltrates with myocyte necrosisCorrect. Lymphocytic infiltrates with myocyte necrosis are the histologic hallmark of viral myocarditis.
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Answer: E. The patient's recent viral infection and presentation are suggestive of viral myocarditis leading to dilated cardiomyopathy. Lymphocytic infiltrates are characteristic of viral myocarditis. Neutrophilic infiltrates would suggest bacterial myocarditis, and eosinophilic infiltrates are seen in hypersensitivity reactions.