Acute Myocarditis after COVID-19 vaccination: A case report.

INTRODUCTION: The etiology of myocarditis often remains undetermined. A large variety of infectious agents, systemic diseases, drugs, and toxins can cause the disease. We report the case of a 19-year-old man who developed myocarditis three days after Pfizer-BioNTech COVID-19 booster vaccination. CASE REPORT: A 19-year-old man, presenting with troponin-positive acute chest pain, was referred to our department. He had received the Pfizer-BioNTech COVID-19 vaccine three days prior to his admission. The diagnosis of acute myocarditis was confirmed by cardiovascular magnetic resonance imaging. Patient hemodynamic status remained stable during hospitalization. The left ventricular ejection fraction was preserved during hospital stay and at one-month follow-up. We found no evidence for another infectious or autoimmune etiology. CONCLUSION: Although imputability of the vaccine cannot be formally established on the basis of this case report, the findings raise the possibility of an association between mRNA COVID-19 vaccination and acute myocarditis.

[Acute autoimmune myocarditis secondary to Graves' disease: a case report]. / Myocardite aiguë auto-immune secondaire à une maladie de Basedow : à propos d'un cas.

INTRODUCTION: Interactions between heart and thyroid are strong. Main cardiac complications of Graves' disease are supra-ventricular tachycardia or high output cardiac failure, without real myocardial involvement. OBSERVATION: A 40-year-old man with history of refractory Graves' disease was hospitalized for an acute chest pain with elevated cardiac biomarkers and normal coronarography. Acute myocarditis was confirmed by cardiac MRI. We found no evidence for an infectious etiology. We retained the hypothesis of acute autoimmune myocarditis in the context of active Graves' disease. CONCLUSION: Acute myocarditis is an exceptional complication of Graves' disease, with most likely an autoimmune mechanism. Possible occurrence of fulminant rhythmic or hemodynamic complications justify minimal cardiological check-up before introducing beta blockers.

[Particularities of African descent patient's electrocardiogram]. / Particularités de l'électrocardiogramme du patient d'origine Africaine.

Particularities of African descent patient's electrocardiogram have been described for many years. Variations such as higher QRS voltage, early repolarization pattern, precordial T-wave inversion and anterior ST segment elevation associated with T-wave inversion are more frequently observed. Ignorance of these variations can lead to misdiagnosis or therapeutic negligence. We present the electrocardiographic particularities attributed to the patient of African origin.

[Oedematous polyarthritis and myopericarditis as presenting features of periarteritis nodosa]. / Polyarthrite oedémateuse et myopéricardite révélatrices d'une périartérite noueuse.

Remitting symmetrical seronegative synovitis with pitting edema (RS3PE) syndrome is a rare type of seronegative polyarthritis occurring in the elderly. It can be associated to various diseases. We report a case of RS3PE syndrome associated with myopericarditis, leading to the diagnosis of polyarteritis nodosa in a 71-year-old patient admitted to the hospital for a febrile acute polyarthritis with pitting edema of the hands associated with a marked inflammatory syndrome. On second day of hospitalization, a sustained chest pain led to the diagnosis of myopericarditis. Muscular biopsy showed necrotizing vasculitis, characteristic of polyarteritis nodosa. The coexistence of RS3PE and myopericarditis has never been described in the literature. Its association with polyarteritis nodosa is also very rare and only one case has been previously reported.

[Right ventricular failure as the presenting manifestation of a carcinoid syndrome]. / Atteinte cardiaque droite révélatrice d'un syndrome carcinoïde.

We report a 75-year-old woman with a severe and symptomatic valvular tricuspid dysfunction, revealing a carcinoid syndrome, confirmed by an octreotid scan and liver biopsy. Carcinoid heart disease is a common complication of carcinoid syndrome associated with poor prognosis. Despite new pharmacological treatment, valve replacement surgery is the only curative treatment. Early diagnosis and multidisciplinary management could improve prognosis and quality of life of these patients.

[Myocarditis caused by Trichinella spiralis: a case report]. / Myocardite à Trichinella spiralis: à propos d'un cas.

Trichinellosis is a cosmopolitan nematodosis which is rare in the developed countries. Myocarditis represents the most frequent form of cardiac complications, sometimes lethal. The authors report the observation of a 36-years-old patient admitted for trichinellosis, who presented asymptomatic electrocardiographic modifications and a rise in the troponine I. The magnetic resonance imaging (MRI) after gadolinium injection, highlighted an underepicardic late raising rendering the diagnosis of myocarditis highly probable. The paraclinic anomalies were corrected gradually under antiparasitarian treatment. Besides the EKG, the MRI is a non-invasive and repetitive method allowing as well the positive diagnosis as the follow-up of those patients.

[Cardiovascular complications of doping products]. / Complications cardiovasculaires des produits dopants.

Doping is the use of a substance that artificially increases an individual's physical ability for competition purpose. Products and methods used in doping are not without risk, especially at cardiovascular level. Here we review the most common doping substances in sport and their cardiovascular consequences.

[Multi-organ failures during septic shock from Escherichia coli urinary tract infection: catastrophic antiphospholipid syndrome?]. / Défaillance multiviscérale au cours d'un choc septique d'origine urinaire à Escherichia coli: syndrome catastrophique des anticorps antiphospholipides?

INTRODUCTION: Although the presence of antiphospholipid antibodies is not an uncommon fact during infection, their responsibility in serious manifestations can still be debated and questions the existence of an actual catastrophic antiphospholipid syndrome or multivisceral faintings, triggered by the infection only, since the presence of antiphospholipid antibodies is not pathogenous. CASE: A 68-year-old man presented during an Escherichia coli urinary tract infection a septic shock with renal and cardiac insufficiencies, hepatic cytolysis and cholestasis and disseminated intravascular coagulation. There was a significant titer of antiphospholipid antibodies IgG (50 UGPL/ml) with an antibêta2-glycoprotein-1 positivity. The patient quickly recovered with antibiotherapy and intravenous immunoglobulins. DISCUSSION: Diagnosing the pathogeny of multivisceral faintings is founded of the clinical manifestations published during the catastrophic antiphospholipid syndrome, the evolution and the persistence of post recovery antibodies and the comparison with the visceral bouts that the sepsis exclusively as revealed.

[Initial management of ST-elevation myocardial infarction in 2014: From guidelines to practices, survey of 176 French interventional cardiologists]. / Prise en charge initiale du syndrome coronaire aigu avec sus-décalage du segment ST en 2014 : des recommandations à la pratique, enquête auprès de 176 cardiologues interventionnels français.

BACKGROUND: Real life management of myocardial infarction has not recently been evaluated in France. AIMS: To describe ST-elevation myocardial infarction management in France in 2014 and to compare it with current guidelines. METHODS: A multicentre study was performed. An e-mail questionnaire was sent to French interventional cardiologists. Demographic data of interventional cardiologists, procedural aspects of percutaneous coronary intervention, antithrombotic treatments and patient rehabilitation have been investigated. RESULTS: One hundred and seventy-six answers were analysed. Most of centres realized more than 600 annual angioplasties. An average of 209 myocardial infarctions were managed per centre in 2014, more often in academic than in general or private centres (respectively 51, 32 and 17% of infarctions). Anti-GPIIbIIIa (34% of the cases) and thromboaspiration were not systematic but depend on patient's characteristics, according to guidelines. Radial access was favoured in 85% of the cases and increased for the last decade. Drug eluting stents were used in 62% of cases. Unfractionated heparin and enoxaparine accounted for more than 80% of anticoagulants treatments. Overall, use of clopidogrel was as high as that of prasugrel or ticagrelor although clopidogrel is recommended in second-line. Cardiovascular rehabilitation was proposed to more than 50% of patients. CONCLUSION: In spite of heterogeneity of ST-elevation myocardial infarction management in 2014, real-life practices generally comply with current guidelines.

[Infective endocarditis: Clinical features and prognosis between 2004 and 2014 in a non-teaching hospital]. / Endocardite infectieuse : caractéristiques cliniques et pronostic entre 2004 et 2014 dans un hôpital non universitaire.

AIMS: Despite diagnostic and therapeutic advances, infective endocarditis (IE) remains a severe disease. The aim of the study was to describe clinical features and prognosis of patients with IE in a non-teaching hospital and compare them with current data and a similar study conducted 10 years earlier in the same center. METHODS: We performed a single institution retrospective study including all patients with Duke-Li definite IE between 2004 and 2014. RESULTS: Ninety-four patients were included. Results are consistent with current French and international data, including in-hospital death rate of 16%. In accordance with literature, we report on an increase in Staphylococcus and health care-associated IE and endocarditis on pacemaker leads, but without significant difference compared to our previous study. In univariate analyses, renal failure, age over 77 years and Staphylococcus aureus IE were associated with in-hospital mortality. In multivariate analyses, predictors of in-hospital death were renal failure and lack of surgery. There was a non-significant trend of excess mortality in Staphylococcus endocarditis and in patients with heart failure. CONCLUSION: IE remains a severe disease and S. aureus is more often involved. IE seems to be safely managed in a peripheral hospital provided that there is a partnership with a reference hospital.

[Inferior myocardial infarction complicated by complete heart block and cardiac arrest following a gadolinium injection: A case of Kounis syndrome]. / Infarctus du myocarde inférieur compliqué de bloc auriculo-ventriculaire complet et d'arrêt cardiocirculatoire dans les suites d'une injection de gadolinium : à propos d'une observation de syndrome de Kounis.

Kounis syndrome is an allergic acute coronary syndrome. It occurs on healthy or pathological arteries. Its complications, although often benign, can lead to cardiac arrest and death. Its triggering factors are multiple and include contrast products used in diagnostic imaging. We report the case of an 81 years old patient affected by hepatocellular carcinoma, who presented a type 2 Kounis syndrome with inferior myocardial infarction, complicated by cardiac arrest related to complete heart block following a gadoteric acid injection.

[Acute coronary syndrome with impaired left ventricular function in a carbon monoxide poisoning]. / Syndrome coronaire aigu avec dysfonction ventriculaire gauche lors d'une intoxication au monoxyde de carbone.

Carbon monoxide poisoning is the leading cause of death by poisoning in France. Neuropsychological symptoms are most common. We report on a patient with acute coronary syndrome and transient left ventricular dysfunction in carbon monoxide poisoning. Patient improved under hyperbaric oxygen therapy. Coronary angiography shows no significant lesion leading to myocardial stunning diagnose. Patients exposed to carbon monoxide must have systematic cardiac evaluation with electrocardiogram and dosage of biomarkers.

[Acute anterior myocardial infarction as presenting feature of antiphospholipid syndrome related lupus arthritis]. / Infarctus du myocarde antérieur inaugural révélateur d'un syndrome des antiphospholipides dans le cadre d'une polyarthrite lupique.

INTRODUCTION: Antiphospholipid syndrome is an autoimmune disorder causing venous and arterial thrombosis. Acute coronary complications are rare but potentially dramatic. CASE REPORT: We report a 39-year-old woman who presented with an acute anterior myocardial infarction after intravenous corticosteroids as part of the treatment of lupus arthritis and revealing antiphospholipid syndrome. Emergency coronary angiography was performed with drug-eluting stent angioplasty despite the need for anticoagulation and dual antiplatelet therapy. CONCLUSION: Antiplatelet and anticoagulant therapy management is pivotal in patients with antiphospholipid syndrome and acute coronary syndrome to prevent thrombosis recurrence.

[Intraductal papillary mucinous tumor of the pancreas discovered after diagnosis of diabetes mellitus and acute pancreatitis]. / Tumeur intracanalaire papillaire mucineuse du pancréas révélée par une pancréatite aiguë et un diabète.

INTRODUCTION: Imaging of the pancreas soon after diagnosis of diabetes can help screen for tumors. CASE: A 45 year-old man with recently diagnosed insulin-dependent diabetes and no other notable history was found to have intraductal papillary mucinous tumour of the pancreas (IPMTP), a month after an unexplained and benign acute pancreatitis. DISCUSSION: The histology of IPMTP differs from that of the adenocarcinomas usually described in these circumstances, and they are far rarer. Because they carry the risk of malignant degeneration, early diagnosis is important. Surgery is the only curative treatment and should therefore be discussed.

Acute myocardial infarction and coronary artery dissection following rugby-related blunt chest trauma in France.

Coronary artery (CA) dissection following blunt chest trauma is a life-threatening and rare event. Its occurrence in the setting of a contact sport like rugby is even less common. We report on two cases of young adult presenting with segment elevation myocardial infarction related to CA dissection following rugby game. Both were successfully treated with stent implantation. We discuss the mechanism, diagnosis, and optimal management of blunt chest trauma-induced CA dissection.

[Painless anterior acute myocardial infarction in a transplanted heart]. / Infarctus du myocarde antérieur indolore chez un transplanté cardiaque.

Cardiac allograft vasculopathy is the major determinant of long-term survival in patients after heart transplantation. Clinical presentations are congestive heart failure, ventricular arrhythmias and sudden cardiac death. Acute coronary syndrome is a rare presentation of cardiac allograft vasculopathy due to myocardial denervation. We present the case of a 31-year-old patient, who had undergone heart transplantation 6 months earlier and who developed a painless anterior myocardial infarction revealed by syncope. He was successfully treated by percutaneous coronary intervention with drug eluting stent implantation.

[Chronic constrictive pericarditis: new imaging features]. / Péricardite chronique constrictive: apport diagnostique des examens d'imagerie moderne. À propos d'un cas.

We report on a patient hospitalized in cardiology department to explore dyspnea and right ventricular failure evoking constrictive pericarditis. This case is of great interest to review conventional and new imaging features used for the diagnosis of constrictive pericarditis versus restrictive cardiomyopathy.

[Ischemic strokes as a presenting feature of marantic endocarditis despite heparin treatment]. / Accidents cérébraux ischémiques sous héparine révélateurs d'endocardites marastiques.

We report on two patients hospitalized in intensive care unit for ischemic strokes presenting the feature of marantic endocarditis complicating lung's adenocarcinoma. These two cases turned out to be very interesting because of the occurrence of ischemic strokes even though the patients were receiving the recommended treatment, namely anticoagulation with heparin, in well-adjusted doses. The management of nonbacterial thrombotic endocarditis remains a challenge and its mortality is still high.

A family outbreak due to an emm-type 11 multiresistant strain of Streptococcus pyogenes.

Four cases of Streptococcus pyogenes infection due to an emm-type 11 strain, including one with a fatal outcome, occurred within a seven-member family. All strains shared biotype 5, pyrogenic exotoxin genes speB and speC, and resistance to kanamycin, tetracycline, macrolides and lincosamides. The identity of SmaI pulsed-field gel electrophoresis patterns confirmed their clonal origin. This highlights the ability of S. pyogenes to spread rapidly among family members. This first report of a family outbreak due to emm11 S. pyogenes reinforces the importance of surveillance of close family contacts of individuals with invasive streptococcal disease, and provides further support for antibiotic prophylaxis among the elderly.

[Recurrent infective endocarditis. A case report]. / Endocardites infectieuses récidivantes: à propos d'une observation d'endocardite récidivante à streptocoque.

We report the case of a 63-year old patient presenting five infective endocarditis (IE) in a 13-years period, with different types of streptococcus. No entrance way had been found until the last relapse occurring on mitro-aortic bioprosthesis. This recurrence leads to the diagnosis of caecal adenocarcinoma by coloscopy, preceded and guided by PET scanner. It seems to be the initial entrance way which had been unrecognized because of its small size and its particular location, that is very difficult to observe by coloscopy. Recurrent streptococcus IE are rare and severe. When a gut or colic tumor is suspected, PET scan seems to be helpful in etiological survey.