Genetic disorder or toxoplasma myocarditis: a case report of dilated cardiomyopathy with hypertrabeculation in a young asymptomatic woman

Isolated noncompaction of the left ventricle (LV) is a rare disorder, classified as a primary genetic cardiomyopathy by the American Heart Association. The European Society of Cardiology Working Group on Myocardial and Pericardial Diseases classified LV noncompaction as an unclassified cardiomyopathy. LV noncompaction cardiomyopathy characterized by the following features: 1) an altered myocardial wall with prominent trabeculae and deep intertrabecular recesses resulting in thickened myocardium with two layers, consisting of compacted and noncompacted myocardium and 2) continuity between the left ventricular cavity and the deep intertrabecular recesses, which are filled with blood from the ventricular cavity, without evidence of communication with the epicardial coronary artery system. Features of LV noncompaction can overlap with dilated cardiomyopathy, hypertrophic cardiomyopathy (especially the apical variant), and restrictive cardiomyopathy. The phenotypic expression can vary considerably within the same family. The LV noncompaction can rarely occur as a transient phenomenon during myocarditis. We present the case of a 23-year-old patient, admitted to our Department for cardiac evaluation because of ECG changes and cardiac enlargement revealed at thoracic radiography. She had a history of chronic toxoplasmosis. An echocardiography was performed revealing left ventricular enlargement with severe systolic and diastolic dysfunction, diffuse hypokinesia and signs of isolated left ventricular non-compaction. Under these circumstances, we have considered the presence of isolated left ventricular non-compaction. A cardiac Magnetic Resonance Imaging was performed and it sustained the diagnosis. The alternative cause of isolated left ventricular noncompaction (prominent trabeculation due to myocardial toxoplasmosis) was considered improbable.