ABC | Volume 112, Nº6, June 2019

Anatomopathological Correlation Arq Bras Cardiol. 2019; 112(6):793-802 Issa and Benvenuti Pulmonary infiltrate and left ventricular apex obliteration in a young man Figure 4 – PA Chest X-ray PA: bilateral alveolar infiltrate. Figure 5 – Pulmonary angiotomography showing no signs of thromboembolism. and right subcarinal (1.9 x 1.5 cm) chains; there were no tracheal and bronchial alterations; there was a predominantly centrolobular diffuse interstitial and alveolar infiltrate, at times confluent with interlobular thickening, more evident at the bases. There was also bilateral pleural effusion, moderate to the right. (Figure 6) The echocardiogram (November 03, 2011) showed left atrial dilation and left ventricular mid-apical hypertrophy (18 mm), with intense trabeculation and obliteration of its tip, suggestive of endocardial fibrosis (Figure 7), and moderate mitral regurgitation, with signs of papillary muscle fibrosis and hypertrophy, with a left intraventricular gradient of 30 mmHg. A new echocardiogram (November 11, 2011) disclosed left ventricular mid-apical hypertrophy, with intense trabeculation and obliteration of its tip, suggestive of endocardial fibrosis; ejection fraction subjectively estimated at 50% due to discrete apical hypokinesia. Mitral regurgitation was quantified as minimal in this echocardiogram and in subsequent ones (November 16 and 23, 2011). The bronchial lavage (November 11, 2011) did not disclose the presence, by PCR, of Pneumocystis carinii , Mycobacterium tuberculosis , Legionella sp ., Adenovirus, Herpes simplex or Cytomegalovirus. The cytology showed 115 cells/mm³ (leukocytes 9% - 87% polymorphonuclear, 10% lymphocytes, 3% monocytes, 29% macrophages, 62% epithelial cells (7% flat, 21% cylindrical goblet, 72% cylindrical ciliated cells), and absence of bacteria and fungi. The transesophageal echocardiography (November 23, 2011) did not disclose any new alterations (Table 1). A new echocardiogram (December 07, 2011) disclosed a left ventricle with moderate to severe systolic function impairment (Table 1), and a hyperrefringent image was observed in the left ventricle, probably corresponding to the apical hypertrophy of the ventricular septum. Due to lowering of consciousness level, a lumbar puncture was performed (June 29, 2004); the CSF analysis showed ADA (adenosine deaminase) of 2.5 U/L. Tests for Adenovirus, Cytomegalovirus, Herpes simplex, Cryptococcus sp , 795