Myocarditis in adult onset stills disease

Jadhav, P. V.; Nanayakkara, Nihal

doi:10.1111/j.1756-185x.2009.01423.x

Cited by 15 publications

(10 citation statements)

References 6 publications

(8 reference statements)

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“…The main characteristics of the 20 included cases are displayed in Table 1 and Table 2 (Cases 5–24). 1 – 4 , 10 , 16 , 21 , 24 , 27 , 30 , 31 , 39 , 43 – 45 , 48 , 49 , 54 These cases were 15 men (75%) and 5 women (25%). The mean age at myocarditis onset was 29 years (range, 16–57 yr).…”

Section: Resultsmentioning

confidence: 97%

Myocarditis in Adult-Onset Still Disease

et al. 2014

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This study highlights the clinical features, treatments, and outcomes of the rare myocarditis in adult-onset Still disease (AOSD). Among a case series of 57 patients fulfilling either Yamaguchi or Fautrel AOSD criteria and seen between 1998 and 2010, we identified 4 cases of myocarditis. From a comprehensive literature review, we collected 20 additional cases of myocarditis-complicated AOSD. The characteristics of patients with myocarditis were compared with those of AOSD patients without myocarditis.In these 24 myocarditis-complicated AOSD cases, myocarditis occurred early and was present at AOSD onset in 54% of the cases. Myocarditis was often symptomatic (96% of patients) with nonspecific electrocardiographic abnormalities (79% of patients) and a left ventricle ejection fraction ≤50% (67% of patients). Cardiac magnetic resonance imaging and endomyocardial biopsies showed features consistent with myocarditis in 4 patients and a mononuclear interstitial inflammatory infiltrate in 4 others. Steroids alone were effective in 50% of patients with myocarditis. Intravenous immunoglobulins, methotrexate, and tumor necrosis factor-α-blockers were also prescribed and often found effective. Only 1 patient died from cardiogenic shock. Patients with myocarditis-complicated AOSD were younger and more frequently male than patients with AOSD alone. Pericarditis was more frequent in the myocarditis group; white blood cell count, polymorphonuclear cell count, and serum ferritin levels were also higher.Myocarditis is a potentially life-threatening complication of AOSD but responds positively to steroids and other immunomodulatory drugs. Its prognosis remains good (only 1 death occurred), but the condition requires close monitoring of heart function.

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Section: Resultsmentioning

confidence: 97%

Myocarditis in Adult-Onset Still Disease

et al. 2014

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“…Despite being a life-threatening condition, the literature on the association of myocarditis with AOSD remains sparse. Its prevalence is rarely reported even in the largest case series [2-3].…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of acute myocarditis in AOSD (AOSD+M) is not different from the treatment of acute myocarditis in the general population. Steroids are the first-line treatment for AOSD+M patients and have been shown to be effective and sufficient for treatment [2]. Therefore, steroids should not be delayed if there is a high probability of the disease.…”

Section: Discussionmentioning

confidence: 99%

Still's Disease and Myopericarditis

Kumar

Tandon

Lia

et al. 2019

Cureus

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Adult-onset Still’s disease (AOSD) has a vast array of clinical presentations. Myopericarditis is one of the rarest cardiopulmonary manifestations of the disease and due to its rarity, the literature on the association of myocarditis with AOSD is sparse. Herein, we describe an interesting case of a 44-year-old male who presented with chest pain following exertion. He was febrile at the time of presentation and exam revealed inflammation in various joints. Electrocardiogram showed diffuse ST segment elevations in the precordial leads. Laboratory results revealed elevated troponin of 3.17 (<0.05 ng/mL) and CK-MB of 6 ng/mL along with elevated ferritin of 6225 (16-336 ng/mL). Cardiac MRI showed early and late gadolinium enhancement consistent with myocarditis. The patient was started on steroids and non-steroidal anti-inflammatory drugs (NSAID) resulting in clinical improvement. This case highlights the critical importance of diagnosis of pericarditis and myocarditis in patients with AOSD, as a missed diagnosis can lead to significant morbidity and mortality.

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“…Myocarditis has been diagnosed by patient clinical course, but a definitive diagnosis can only be confirmed by EMB. 2) Data from an AOSD patient with myocarditis showed that EMB had been performed six weeks after onset, and results showed mononuclear cell infiltration and fibrosis. 3) In this study, EMB was performed ten days after the suspected onset of heart failure and found cardiac muscle degeneration, fibrosis and infiltration of neutrophil cells.…”

Section: Discussionmentioning

confidence: 99%

Endomyocardial Biopsy and Magnetic Resonance Imaging of Acute Myocarditis with Adult-Onset Still's Disease

et al. 2014

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A 36-year-old female with a high-grade fever and epigastric abdominal pain was prescribed antibiotics, but developed hypoxia and dyspnea. An echocardiography revealed diffuse hypokinesis and massive pericardial effusion, after which diagnostic cardiac catheterization and an endomyocardial biopsy (EMB) were peformed to reveal fibrosis and infiltration of inflammation cells composed primarily of neutrophils. Clinical manifestation of a spiking fever, leukocytosis, elevated ferritin levels, skin rash and EMB findings led to a diagnosis of adult-onset Still's disease (AOSD) with acute myocarditis. Pulse therapy of intravenous methylprednisolone was performed for three days, followed by a daily dose of prednisone (60 mg). After a course of steroid therapy for fever and pericardial effusion, and conducting a left ventricular ejection fraction, the patient showed improvement and was discharged asymptomatic within 32 days of admission. This study is the first to report on a case of myocarditis in AOSD diagnosed by neutrophil infiltration in the myocardium.

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Myocarditis in adult onset stills disease

Cited by 15 publications

References 6 publications

Myocarditis in Adult-Onset Still Disease

Myocarditis in Adult-Onset Still Disease

Still's Disease and Myopericarditis

Endomyocardial Biopsy and Magnetic Resonance Imaging of Acute Myocarditis with Adult-Onset Still's Disease

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