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1.
Bull Cancer ; 106(11): 1050-1056, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31627906

RESUMO

Traditional cancer therapies, such as treatment with anthracyclines and chest radiation, are known to induce cardiovascular complications. Currently, the increase of cancer therapies will involve new mechanisms such as cancer immunotherapies, also called immune checkpoint inhibitors (PD-1, PD-L1 and CTLA-4 inhibitors). These treatments have shown long-term remissions in subgroup of cancers, including melanomas, non-small-cell lung cancer, urothelial carcinoma, renal cell carcinoma, squamous cell carcinoma of the head and neck and colorectal cancer. Although these treatments will change the natural course of these cancers, they may sometimes induce cardiovascular complications, which has been reported as about 1 % in the literature. Currently, the physicians must keep in mind one uncommon but severe cardiac complication: auto-immune myocarditis. The clinical presentation may include various symptoms like chest pain, heart failure or rhythm disorders. In this situation, a baseline cardiologic check-up before starting cancer immunotherapy may be very helpful. Cardiac biomarkers (troponin and brain natriuretic peptide) and 12-lead resting electrocardiogram must be promptly performed when myocarditis is suspected. A cardiologist's opinion must be requested in emergency to discuss both a transthoracic echocardiography and the appropriate treatment (stopping immunotherapy, adding immunosuppressive treatment such as corticoids) and the monitoring in an intensive care unit. Cardiac MRI and endomyocardial biopsies may help to approach the final diagnosis. In this situation, other cancer therapies may be discussed.


Assuntos
Imunoterapia Adotiva/efeitos adversos , Miocardite/etiologia , Antígeno B7-H1/antagonistas & inibidores , Antígeno CTLA-4/antagonistas & inibidores , Humanos , Miocardite/diagnóstico , Miocardite/imunologia , Neoplasias/terapia
2.
J Vet Diagn Invest ; 31(6): 893-898, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31646958

RESUMO

We investigated deaths in a group of feedlot steers in Argentina. The main findings in 3 steers autopsied were pulmonary congestion and edema, necrotizing myocarditis, pericarditis, suppurative leptomeningitis, and bronchopneumonia. Histophilus somni was detected by bacterial culture and immunohistochemistry in the hearts of the 3 animals. Partial sequences of the 16S rRNA gene of a H. somni isolate had 99% similarity with other H. somni sequences in GenBank. Most reports of H. somni septicemia in cattle originate from North America and western Europe. There is scant information about cardiac histophilosis in South America. A survey of diagnostic laboratory personnel in 7 South American countries documented various forms of bovine histophilosis in Argentina, Brazil, Uruguay, and Venezuela.


Assuntos
Doenças dos Bovinos/diagnóstico , Meningite/veterinária , Miocardite/veterinária , Infecções por Pasteurellaceae/veterinária , Pasteurellaceae/isolamento & purificação , Animais , Argentina , Brasil , Bovinos , Doenças dos Bovinos/microbiologia , Masculino , Meningite/diagnóstico , Meningite/microbiologia , Miocardite/diagnóstico , Miocardite/microbiologia , Pasteurellaceae/classificação , Infecções por Pasteurellaceae/diagnóstico , Infecções por Pasteurellaceae/microbiologia , RNA Bacteriano/análise , RNA Ribossômico 16S/análise , Uruguai , Venezuela
4.
EBioMedicine ; 47: 329-340, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474552

RESUMO

BACKGROUND: The objective of the current study was to study the molecular mechanism(s) underlying cardiac troponin I autoantibody (cTnIAAb) binding to cardiomyocyte and resultant myocardial damage/dysfunction. METHODS: cTnIAAb was purified from serum of 10 acute myocardial infarction (AMI) patients with left ventricular remodeling. Recombinant human cTnI was used to generate three mouse-derived monoclonal anti-cTnI antibodies (cTnImAb1, cTnImAb2, and cTnImAb3). The target proteins in cardiac myocyte membrane bound to cTnImAb and effect of cTnIAAb and cTnImAb on apoptosis and myocardial function were determined. FINDINGS: We found that cTnIAAb/cTnImAb1 directly bound to the cardiomyocyte membraneα-Enolase (ENO1) and triggered cell apoptosis via increased expression of ENO1 and Bax, decreased expression of Bcl2, subsequently activating Caspase8, Caspase 3, phosphatase and tensin homolog (PTEN) while inhibiting Akt activity. This cTnIAAb-ENO1-PTEN-Akt signaling axis contributed to increased myocardial apoptosis, myocardial collagen deposition, and impaired systolic dysfunction. INTERPRETATION: Results obtained in this study indicate that cTnIAAb is involved in the process of ventricular remodeling after myocardial injury. FUND: The National Natural Science Foundation of China (Grant#: 81260026).


Assuntos
Autoanticorpos/imunologia , Miocardite/etiologia , Miocardite/metabolismo , PTEN Fosfo-Hidrolase/metabolismo , Transdução de Sinais , Troponina I/imunologia , Idoso , Idoso de 80 Anos ou mais , Animais , Apoptose , Autoanticorpos/efeitos adversos , Biomarcadores , Membrana Celular/imunologia , Membrana Celular/metabolismo , Células Cultivadas , Modelos Animais de Doenças , Feminino , Testes de Função Cardíaca , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , Modelos Biológicos , Miocardite/diagnóstico , Miocardite/fisiopatologia , Miocárdio/imunologia , Miocárdio/metabolismo , Miócitos Cardíacos/metabolismo , Ligação Proteica , Proteínas Proto-Oncogênicas c-akt/metabolismo
5.
Int J Mol Sci ; 20(18)2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31489895

RESUMO

Inflammation is a physiological process by which the body responds to external insults and stress conditions, and it is characterized by the production of pro-inflammatory mediators such as cytokines. The acute inflammatory response is solved by removing the threat. Conversely, a chronic inflammatory state is established due to a prolonged inflammatory response and may lead to tissue damage. Based on the evidence of a reciprocal regulation between inflammation process and calcium unbalance, here we described the involvement of a calcium sensor in cardiac diseases with inflammatory drift. Indeed, the Ca2+/calmodulin-dependent protein kinase II (CaMKII) is activated in several diseases with an inflammatory component, such as myocardial infarction, ischemia/reperfusion injury, pressure overload/hypertrophy, and arrhythmic syndromes, in which it actively regulates pro-inflammatory signaling, among which includes nuclear factor kappa-B (NF-κB), thus contributing to pathological cardiac remodeling. Thus, CaMKII may represent a key target to modulate the severity of the inflammatory-driven degeneration.


Assuntos
Proteína Quinase Tipo 2 Dependente de Cálcio-Calmodulina/metabolismo , Cardiopatias/metabolismo , Miocardite/metabolismo , Miocárdio/metabolismo , Animais , Biomarcadores , Cálcio/metabolismo , Suscetibilidade a Doenças , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Sistema Imunitário/imunologia , Sistema Imunitário/metabolismo , Sistema Imunitário/patologia , Miocardite/diagnóstico , Miocardite/etiologia , Miocárdio/patologia , Estresse Oxidativo , Transdução de Sinais
6.
Pediatr Cardiol ; 40(8): 1638-1644, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31485699

RESUMO

Troponin is a marker that displays cardiac injury quickly and accurately. In adults, troponin elevation is usually associated with coronary artery disease and requires urgent cardiac catheterization. In healthy children, myocardial injury is rare and may develop due to many different causes. Therefore, troponin elevation in children and adolescents does not usually require emergency cardiac catheterization. The aim of this study is to assess the most common causes of troponin elevation in children and adolescents and to show which diagnostic tests are helpful in assessing pediatric patients with elevated troponin. Patients who had been diagnosed with troponin I elevation (> 0.06 ng/ml) at Dr. Sami Ulus Maternity, Children's Health and Disease Training and Research Hospital between 2007 and 2018 were retrospectively evaluated. Patients undergoing cardiac surgery and those with severe congenital heart disease were excluded from the study. The medical records of the patients were examined and age, gender, diagnostic tests, and diagnosis were evaluated. During the study period, the records of 972 patients were obtained. 213 patients were excluded from the study because of heart surgery, congenital heart disease, and neonatal asphyxia or sepsis. Of the remaining 759 patients, 58% were male, 42% were female, and the median age was 4 years (3 days to 17 years). The most frequent causes are myopericarditis (n: 164), drug intoxications (n: 85), carbon monoxide poisoning (n: 74), perimyocarditis (n: 65), and intensive inhalation ß agonist use in acute asthma and lower respiratory tract infections (n: 70). Patients diagnosed with myocarditis and myopericarditis were admitted with a complaint of chest pain, and the diagnosis was made by history, physical examination, ECG, and echocardiographic findings. Unlike adults, troponin I elevation may be associated with many cardiac and non-cardiac pathologies in children. The most common pathologies in cardiac etiology are myopericarditis and perimyocarditis and can be diagnosed by history, physical examination, ECG, and echocardiography. Cardiac catheterization is not necessary except for rare cardiac pathologies and does not alter the prognosis.


Assuntos
Miocardite/sangue , Troponina I/sangue , Adolescente , Biomarcadores/sangue , Intoxicação por Monóxido de Carbono/sangue , Intoxicação por Monóxido de Carbono/diagnóstico , Estudos de Casos e Controles , Criança , Pré-Escolar , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/sangue , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Miocardite/diagnóstico , Estudos Retrospectivos
7.
Congenit Heart Dis ; 14(5): 868-877, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31432626

RESUMO

Myocarditis has a variable clinical presentation and there is still debate regarding accurate diagnostic criteria. Adding to the controversy surrounding this diagnosis, there is no clear consensus for the treatment or ongoing follow-up of patients with myocarditis. All of this makes the diagnosis and management of myocarditis a particular challenge in the pediatric population. Furthermore, the literature with respect to this topic is dynamic and ever-changing. In this review article, we aim to review and summarize the common clinical presentations of myocarditis, along with the latest recommendations for diagnostic criteria, treatment, and follow-up of patients with myocarditis.


Assuntos
Ecocardiografia/métodos , Eletrocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Miocardite/epidemiologia , Miocárdio/patologia , Biópsia , Criança , Saúde Global , Humanos , Incidência , Miocardite/diagnóstico
8.
J Assoc Physicians India ; 67(3): 91-92, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31304720
9.
Pediatr Cardiol ; 40(6): 1171-1174, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31177303

RESUMO

The objective of this study was to describe a cohort of patients with clinical myocarditis and normal left ventricular (LV) systolic function on admission. A retrospective chart review at seven tertiary pediatric hospitals identified patients aged < 19 years admitted with an ICD-9 code of myocarditis between 2008 and 2012. Patients were excluded if admission LV systolic ejection fraction was < 50%, fractional shortening (FS) was < 28% or if the admitting or consulting cardiologist did not suspect myocarditis. A total of 75 patients met inclusion criteria. The median age was 15.5 years with an Interquartile Range (IQR) of 13.6-16.6. 33% were female. Patients presented most commonly with chest pain (75%) and dyspnea (24%). On admission, median B-type natriuretic peptide (BNP) was 132 pg/mL (IQR 57-689) and median troponin I (TnI) was 8.4 ng/mL (IQR 2.0-20.3). Electrocardiogram revealed ST elevation in the majority (55%). Magnetic resonance imaging was obtained on 40%, with 63% of those showing evidence of inflammation. Therapies included inotropic support (15%), mechanical ventilation (12%), antiarrhythmic medications (9%), and Extracorporeal Membrane Oxygenation (5%). Those with poor outcomes were noted to have significantly higher BNP, TnI, and creatine kinase levels on presentation. One patient was transplanted and 35% were discharged on heart failure medications. At one year follow-up one patient had died of unspecified causes, 15% required readmission for cardiac reasons, and 21% continued on heart failure medications. The risk associated with clinical myocarditis in the setting of normal ventricular function at presentation may be higher than previously suspected.


Assuntos
Miocardite/diagnóstico , Função Ventricular Esquerda/fisiologia , Adolescente , Antiarrítmicos/uso terapêutico , Cardiotônicos/uso terapêutico , Dor no Peito/etiologia , Eletrocardiografia , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Humanos , Masculino , Miocardite/mortalidade , Miocardite/terapia , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Troponina I/sangue
10.
Cardiology ; 142(3): 167-174, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31189164

RESUMO

PURPOSE: The aim of this study was to quantify the value of various clinical, laboratory, and instrumental signs in the diagnosis of myocarditis in comparison with morphological studies of the myocardium. METHODS: In 100 patients (65 men, 44.7 ± 12.5 years old) with "idiopathic" arrhythmias (n = 20) and dilated cardiomyopathy (DCM; n = 80), we performed the following: 71 endomyocardial biopsies (EMB), 13 intraoperative biopsies, 5 studies of explanted hearts, and 11 autopsies with virus investigation (real-time PCR) of the blood and myocardium. Antiheart antibodies (AHA) were also measured as well as cardiac CT (n = 45), MRI (n = 25), and coronary angiography (n = 47). The comparison group included 50 patients (25 men, 53.7 ± 11.7 years old) with noninflammatory heart diseases who underwent open heart surgery. RESULTS: Active/borderline myocarditis was diagnosed in 76.0% of the study group and in 21.6% of patients in the comparison group (p < 0.001). The myocardial viral genome was observed more frequently in patients in the comparison group than in the study group (65.0 and 40.2%; p < 0.01). We evaluated the diagnostic value of noninvasive markers of myocarditis. The panel of AHA had the greatest importance in the identification of myocarditis: sensitivity was 81.5%, and the positive and negative predictive values were 75.0 and 60.5%. This defined the diagnostic value of noninvasive markers of myocarditis and established a diagnostic algorithm providing an individual assessment of the likelihood of myocarditis development. CONCLUSION: AHA have the greatest significance in the diagnosis of latent myocarditis in patients with "idiopathic" arrhythmias and DCM. The use of a complex of noninvasive criteria allows the probability of myocarditis to be estimated and the indications for EMB to be determined.


Assuntos
Anticorpos/análise , Arritmias Cardíacas/diagnóstico , Cardiomiopatia Dilatada/diagnóstico , Miocardite/diagnóstico , Miocárdio/patologia , Adulto , Antiestreptolisina/sangue , Arritmias Cardíacas/sangue , Biópsia , Técnicas de Imagem Cardíaca , Cardiomiopatia Dilatada/sangue , Diagnóstico Diferencial , Feminino , Genoma Viral , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/sangue , Miocárdio/imunologia , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Federação Russa
11.
Cardiol Young ; 29(7): 917-921, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31198128

RESUMO

There are a variety of causes of acute heart failure in children including myocarditis, genetic/metabolic conditions, and congenital heart defects. In cases with a structurally normal heart and a negative personal and family history, myocarditis is often presumed to be the cause, but we hypothesise that genetic disorders contribute to a significant portion of these cases. We reviewed our cases of children who presented with acute heart failure and underwent genetic testing from 2008 to 2017. Eighty-seven percent of these individuals were found to have either a genetic syndrome or pathogenic or likely pathogenic variant in a cardiac-related gene. None of these individuals had a personal or family history of cardiomyopathy that was suggestive of a genetic aetiology prior to presentation. All of these individuals either passed away or were listed for cardiac transplantation indicating genetic testing may provide important information regarding prognosis in addition to providing information critical to assessment of family members.


Assuntos
Predisposição Genética para Doença/epidemiologia , Insuficiência Cardíaca/genética , Miocardite/genética , Doença Aguda , Adolescente , Criança , Feminino , Testes Genéticos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/patologia , Humanos , Lactente , Recém-Nascido , Masculino , Miocardite/complicações , Miocardite/diagnóstico , Estudos Retrospectivos
12.
Internist (Berl) ; 60(9): 973-981, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31123761

RESUMO

Eosinophilic myocarditis is a rare condition with good treatment options, which can be difficult to diagnose. The clinical presentation can vary from asymptomatic to life-threatening forms. This article describes the case of a 44-year-old woman who suffered from vertigo, chest pain and dyspnea. The woman presented with an intermittent atrioventricular (AV) block II Mobitz type II° and mild impairment of left ventricular ejection fraction. Hypereosinophilia in the peripheral blood, cardiac magnetic resonance imaging (MRI) and endomyocardial biopsy led to the diagnosis of eosinophilic myocarditis, most likely as a result of an allergic reaction to Aspergillus fumigatus. A general treatment recommendation cannot be made due to the lack of evidence-based guidelines; however, recent scientific studies confirmed timely, high-dose steroid administration over several months to be the mainstay of treatment of eosinophilic myocarditis. The following article may be helpful in the early diagnosis and treatment of this underdiagnosed and insidious disease.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Eosinofilia/diagnóstico , Miocardite/diagnóstico , Miocárdio/patologia , Adulto , Biópsia , Eosinofilia/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Miocardite/patologia
13.
BMJ Case Rep ; 12(4)2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036741

RESUMO

The incidence of Lyme disease in the USA is 8 per 100 000 cases and 95% of those occur in the Northeastern region. Cardiac involvement occurs in only 1% of untreated patients. We describe the case of a 46-year-old man who presented with chest pressure, dyspnoea, palpitations and syncope. He presented initially with atrial fibrillation with rapid ventricular response, a rare manifestation of Lyme carditis. In another hospital presentation, he had varying degrees of atrioventricular block including Mobitz I second-degree heart block. After appropriate antibiotic treatment, he made a full recovery and his ECG normalised. The authors aim to urge physicians treating patients in endemic areas to consider Lyme carditis in the workup for patients with atrial fibrillation and unexplained heart block, as the associated atrioventricular nodal complications may be fatal.


Assuntos
Fibrilação Atrial/etiologia , Bloqueio Atrioventricular/etiologia , Doença de Lyme/diagnóstico , Miocardite/diagnóstico , Administração Intravenosa , Antibacterianos/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Western Blotting/métodos , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Eletrocardiografia , Humanos , Doença de Lyme/complicações , Doença de Lyme/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Doenças Raras , Síncope/etiologia , Resultado do Tratamento
14.
J Chromatogr B Analyt Technol Biomed Life Sci ; 1118-1119: 148-156, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31039544

RESUMO

A simple, rapid and sensitive HPLC-MS/MS method for simultaneous determination of 4 of amino acids, guanidinoacetic acid, S-adenosylmethionine and S-adenosylhomocysteine in human plasma was developed and validated. The method requires no tedious sample preparation, derivatization reagents or ion-pairing reagents. Samples were prepared by combining plasma with a chilled mixture of acetonitrile (ACN) and water, followed by centrifugation and diluting the supernatant with 2 volumes of water. Analytes were detected with multiple reaction monitoring using a positive scan mode with electrospray ionization (ESI). In the assay, all the analytes showed good linearity over the investigated concentration range (r > 0.99). The accuracy expressed in relative error (RE) was between -5.0% and 13.2%, and the precision expressed in coefficient of variation (CV) ranged from 0.6% to 14.7%. In the two spiked levels (low and high), the averaged recoveries of analytes were between 45.0% and 110.9% and the recovery of internal standard was 92.0%. This method was successfully applied to studying the concentration changes of endogenous creatine (Cr) synthesis precursors in the plasma of children with viral myocarditis after intravenous administration of phosphocreatine (PCr).


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Creatina/sangue , Miocardite/sangue , Espectrometria de Massas em Tandem/métodos , Viroses/sangue , Aminoácidos/sangue , Aminoácidos/química , Aminoácidos/metabolismo , Criança , Creatina/química , Creatina/metabolismo , Humanos , Modelos Lineares , Miocardite/diagnóstico , Miocardite/virologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Viroses/diagnóstico , Viroses/virologia
15.
Rev Soc Bras Med Trop ; 52: e20180461, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31141054

RESUMO

Dirofilariasis is a little-known zoonosis, with dogs and cats as definitive hosts. It is caused by nematodes and transmitted by mosquito bites. We report the case of a 67-year-old man with a consumptive syndrome with two subpleural pulmonary opacities. A transthoracic lung biopsy revealed a Dirofilaria worm. Myocardial nuclear magnetic resonance (NMR) demonstrated dilated cardiomyopathy after myocarditis related to dirofilariasis. Human infection is rare and occurs accidentally. The most common radiological alteration is a mainly subpleural coin lesion. Dirofilariasis is a neglected emergent disease and knowledge about it is important for differential diagnoses from neoplastic pulmonary nodules.


Assuntos
Dirofilariose/complicações , Pneumopatias Parasitárias/complicações , Miocardite/etiologia , Idoso , Dirofilariose/diagnóstico , Humanos , Pneumopatias Parasitárias/diagnóstico , Masculino , Miocardite/diagnóstico
16.
BMJ Case Rep ; 12(4)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975785

RESUMO

Mesalazine (5-aminosalicylic acid)-based products are a widely used treatment for inflammatory bowel disease in children and adults. Associated myopericarditis is an uncommon but recorded phenomenon related to drug hypersensitivity. Unless recognised, this important complication may culminate in the development of dilated cardiomyopathy and severe heart failure. We report the case of a boy with Crohn's disease who developed myopericarditis 14 days after starting treatment with mesalazine. Discontinuation of the drug rapidly led to normalisation of left ventricular structure and function, and a parallel improvement in the levels of plasma N-terminal pro-B-type natriuretic peptide and other markers of myocardial damage. Clinicians should be aware of this potentially life-threatening adverse effect of mesalazine therapy, which is quickly and fully reversible on cessation of the agent.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Doença de Crohn/tratamento farmacológico , Mesalamina/efeitos adversos , Miocardite/diagnóstico , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Adolescente , Diagnóstico Diferencial , Humanos , Masculino , Miocardite/induzido quimicamente , Miocardite/metabolismo
17.
Clin Rheumatol ; 38(8): 2275-2280, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30976930

RESUMO

We report a case of a 56-year-old woman with an alleged diagnosis of an acute coronary syndrome that was later correctly identified in our Cardiology Unit as antisynthetase syndrome (AS) with inflammatory cardiac involvement. In this case report, we focus on clinical features of this rare autoimmune disease aiming to provide useful tips to achieve correct differential diagnosis according to updated international guidelines and recommendations, especially in cases of concurrent disease-related myocarditis.


Assuntos
Erros de Diagnóstico , Miocardite/complicações , Miocardite/diagnóstico , Miosite/complicações , Miosite/diagnóstico , Síndrome Coronariana Aguda/diagnóstico , Autoimunidade , Cardiologia , Ecocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Reumatologia , Sístole
18.
Leg Med (Tokyo) ; 38: 1-4, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30861484

RESUMO

Acute myocarditis is related to a significant number of sudden deaths among young adults and its diagnosis is often demanded to post-mortem investigations performed on a forensic setting. Eosinophilic myocarditis (EM) is a rare form of myocarditis that is pathologically characterized by myocardial inflammation with eosinophils, often in association with elevated levels of circulating blood eosinophils. The sudden death of a 19-year-old boy with no past medical history is reported. Diagnosis of fatal acute EM was performed after a comprehensive investigation including an in-depth analysis of anamnestic and circumstantial data, and complete autopsy followed by toxicologic and cardio-pathological investigations. Discussion focuses on the forensic issues related to diagnosis and therapy of this rare form of acute myocarditis. As acute EM may be patchy, extensive myocardial sampling is mandatory in order to recognize the extent and the phase of the disease. An early diagnosis is the basis for a timely therapy, which is the key-point for prevent extensive myocardial damage, allowing a better outcome, especially when EM is acute and necrotizing. However, as demonstrated from the case herein reported, the course of EM is sometimes fulminant and does not allow any therapy nor even clinical diagnosis. Finally, this paper serves as reminder to consider this infrequent disease in differential diagnosis when facing with a sudden death, even in a young subject and in the absence of any prodrome.


Assuntos
Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/patologia , Eosinofilia/complicações , Eosinofilia/patologia , Patologia Legal , Miocardite/complicações , Miocardite/patologia , Miocárdio/patologia , Doença Aguda , Adulto , Autopsia , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Humanos , Masculino , Miocardite/diagnóstico , Necrose , Adulto Jovem
19.
BMC Infect Dis ; 19(1): 266, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885147

RESUMO

BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral infectious disease with high mortality. It causes multiple organ dysfunction; however, myocarditis has never been reported as a complication with SFTS. CASE PRESENTATION: A 62-year-old previously healthy woman developed fever, fatigue, diarrhea, and a mild consciousness disorder. She visited a local clinic, and laboratory data showed leukocytopenia, thrombocytopenia, and elevation of the aspartate aminotransferase level. She was transferred to Kagoshima University Hospital and diagnosed as having SFTS by real-time reverse transcription polymerase chain reaction. Subsequently, her blood pressure gradually decreased despite fluid resuscitation and vasopressor administration. Based on elevated toroponin I levels in serum, a transient diffuse left ventricular hypokinesis and wall thickening in echocardiography, diffuse ST elevation in electrocardiography, and exclusion of other heart diseases, she was diagnosed as having fulminant myocarditis. After hemodynamic support with inotropic agents, she recovered near normal cardiac function. She was discharged to home on day 28. CONCLUSIONS: We report the first case of fulminant myocarditis associated with SFTS.


Assuntos
Infecções por Bunyaviridae/complicações , Febres Hemorrágicas Virais/complicações , Miocardite/etiologia , Trombocitopenia/complicações , Doenças Transmissíveis Emergentes/complicações , Ecocardiografia , Eletrocardiografia , Feminino , Febre/etiologia , Humanos , Leucopenia , Pessoa de Meia-Idade , Miocardite/complicações , Miocardite/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real , Síndrome
20.
BMC Infect Dis ; 19(1): 252, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30871501

RESUMO

BACKGROUND: During fulminant meningococcal septicaemia, meningococci are often observed in the cerebrospinal fluid (CSF) although the patients have frequently no meningeal symptoms. Meningococcal meningitis, by contrast, usually features clinical meningeal signs and biochemical markers of inflammation with elevated white blood cell count (pleiocytosis) in the CSF. Cases of typical symptomatic meningitis without these biochemical features are uncommon in adults. CASE PRESENTATION: A 21-year-old male presented with meningococcal purpura fulminans and disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome requiring hospitalization in the Intensive Care Unit. Despite typical meningeal clinical signs, lumbar puncture showed no pleiocytosis, normal glycorachia and normal proteinorachia, whereas the lactate concentration in the CSF was high (5.8 mmol/L). CSF culture showed a high inoculum of serogroup C meningococci. On day 2, after initial improvement, a recurrence of hypotension led to the diagnosis of acute meningococcal myocarditis, which evolved favourably within a week. During the hospitalization, distal ischemic and necrotic lesions were observed, predominantly on the fingertips, which were treated with local and systemic vasodilators. CONCLUSIONS: We report a rare case of adult meningococcal disease characterized by an intermediate form of meningitis between purulent meningitis and meningeal inoculation from fulminant meningococcal septicaemia, without classical signs of biological inflammation. It highlights the diagnostic value of CSF lactate, which may warrant administration of a meningeal dosing regimen of beta-lactam antibiotics. This case also demonstrates the potential severity of meningococcal myocarditis; we discuss its pathophysiology, which is distinct from other sepsis-related cardiomyopathies. Finally, the observed effects of vasodilators on the meningococcal skin ischemia in this case encourages future studies to assess their efficacy in DIC-associated necrosis.


Assuntos
Meningite Meningocócica/diagnóstico , Miocardite/diagnóstico , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Púrpura Fulminante/diagnóstico , Adulto , Humanos , Masculino , Meningite Meningocócica/microbiologia , Miocardite/microbiologia , Neisseria meningitidis Sorogrupo C/genética , Neisseria meningitidis Sorogrupo C/fisiologia , Púrpura Fulminante/microbiologia , Adulto Jovem
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