A cohort study reveals myocarditis to be a rare and life-threatening presentation of large vessel vasculitis

Bechman, Katie; Gopalan, Deepa; Nihoyannopoulos, Petros; Mason, Justin C.

doi:10.1016/j.semarthrit.2017.03.023

Cited by 28 publications

(26 citation statements)

References 40 publications

(52 reference statements)

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“…Few data support the use of other immunosuppressive agents, such as cyclophosphamide or cyclosporine, in treating VNM. The use of cyclophosphamide has been historically limited to severe cases of inflammatory HF in the context of CTDs, SSc and SLE among others with both acute [51] and subacute/chronic myocarditis [11,55,56,57,58]; moreover, cyclophosphamide was used to treat eosinophilic granulomatosis with polyangiitis with chronic inflammatory DCM [59] and acute life-threatening myocarditis in large vessel vasculitides [60]. The use of cyclophosphamide in ANCA-associated vasculitis with cardiac involvement is still recommended [61]; however, in other clinical scenario, the use of cyclophosphamide is limited by its potential cardiotoxicity [62].…”

Section: Other Immunosuppressive Drugsmentioning

confidence: 99%

Therapeutic strategies for virus-negative myocarditis: a comprehensive review

Luca

Campochiaro

Sartorelli

et al. 2020

European Journal of Internal Medicine

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Section: Other Immunosuppressive Drugsmentioning

confidence: 99%

Therapeutic strategies for virus-negative myocarditis: a comprehensive review

Luca

Campochiaro

Sartorelli

et al. 2020

European Journal of Internal Medicine

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“…Bechman et al reported only 4 out of 139 registered adult patients with large vessel vasculitis developed acute myocarditis at onset. All 4 patients presented with life-threatening heart failure, but they were successfully treated with IVCY (n=3) or tocilizumab (n=1) 8 . Talwar et al reported clinical and subclinical in ammatory myocarditis in 24 out of 54 patients 9 .…”

Section: Discussionmentioning

confidence: 99%

Tocilizumab for juvenile Takayasu arteritis complicated with acute heart failure at onset

Kanamori¹,

Ogura²,

Ishikura³

et al. 2020

Preprint

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Background We encountered a 12-year-old girl with Takayasu arteritis (TA) who developed acute heart failure at onset. There have been few reports of specific treatment for acute heart failure (AHF) in TA. We successfully treated her with intravenous methylprednisolone and tocilizumab. Case presentation The patient developed palpitations and shortness of breath 3 weeks before admission. Her symptoms exacerbated rapidly and she finally entered our hospital intensive care unit due to respiratory distress and tachycardia. Blood pressure values measured on the left arm and bilateral legs were paradoxically lower than values taken on the right arm. Chest X-ray revealed a severely enlarged heart. Contrast computed tomography showed an expanded aorta, aortic aneurysm, meandering, and irregular diameter of the aorta. The left ventricular ejection fraction (LVEF) was 20% on cardiac ultrasound. Laboratory examination suggested acute inflammation and positivity of HLA-B52. Her medical condition was finally diagnosed as TA with AHF. Along with inotropes and diuretics, methylprednisolone pulse therapy was administered for 3 days on the 2nd and 12th hospital day followed by oral prednisolone. Cardiac function was slightly improved. As intravenous cyclophosphamide therapy requires hydration and may exacerbate AHF, we started weekly subcutaneous tocilizumab treatment (162 mg/week) from the 20th hospital day. Inotropes were discontinued on the 51st hospital day and her LVEF had improved to 37.5% on the 63rd day when she was discharged. Conclusions Tocilizumab could be a significant treatment option for acute heart failure in juvenile TA.

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“…Etiologic hypotheses include systemic autoimmune diseases [164][165][166][167][168], drug toxicity [169], infections [170][171][172], and complex combination of autoimmunity, infections and drug toxicity [173]. Infections reported in GCM include coxsackie B2 virus [170], parvovirus B19 [171], HCMV [172] and HIV1 infection [173][174][175][176][177][178][179][180][181][182][183][184]. In most cases, GCM is an isolated entity, while in about one-fifth of cases GCM occurs in association with autoimmune/immune-mediated diseases (Table 4.7), infections, drug toxicity, or syndromes such as immune reconstitution inflammatory syndrome (IRIS) in patients undergoing highly active antiretroviral therapy (HAART) against human immunodeficiency virus type 1 (HIV-1) [173,184,185] or even in patients taking common medications such as amoxicillin [183].…”

Section: Giant Cell Myocarditis and Geneticsmentioning

confidence: 99%