Myocarditis and intramural coronary vasculitis in polyarteritis nodosa: an unusual treatable form of heart failure

Autoimmune heart disease is a non-random condition characterised by immune system-mediated aggression against cardiac tissue. Cardiac changes often exhibit nonspecific features and, if unrecognised, can result in fatal outcomes even among seemingly healthy young individuals. In the absence of reliable medical history, the primary challenge lies in differentiating between the various cardiopathies. Numerous immunohistochemical and genetic studies have endeavoured to characterise distinct types of cardiopathies, facilitating their differentiation during autopsy examinations. However, the presence of a standardised protocol that forensic pathologists can employ to guide their investigations would be beneficial. Hence, this summary aims to present the spectrum of autoimmune cardiopathies, including emerging insights such as SARS-CoV-2-induced cardiopathies, and proposes the utilisation of practical tools, such as blood markers, to aid forensic pathologists in their routine practice.

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“…The involved cardiac structure and clinical manifestations are summarised in Table 6 [ 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ].…”

Section: Cardiopathy In Polyarteritis Nodosamentioning

confidence: 99%

“…Medicina 2023,59, 1364. https://doi.org/10.3390/medicina59081364 https://www.mdpi.com/journal/medicina…”

mentioning

confidence: 99%

Autoimmune Heart Disease: A Comprehensive Summary for Forensic Practice

et al. 2023

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Kawasaki disease with acute myocarditis in an adolescent

et al. 2021

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A previously healthy 16-year-old adolescent was admitted to our hospital with fever, sore throat, diarrhoea, strawberry tongue, rashes on lower extremities, and pain in the neck, abdomen and joints. He was initially diagnosed with IgA vasculitis triggered by acute pharyngitis. Despite antibiotic treatment, he gradually developed multiorgan failure and cardiac shock. Cardiac catheterisation did not show any signs of coronary artery disease. Subsequently, he developed serious rhabdomyolysis and peripheral extremity necrosis, suggesting peripheral arteritis. Although blood culture results were negative, he received endotoxin adsorption therapy, but it was ineffective. Hence, we suspected Kawasaki disease (KD). We administered high-dose intravenous immunoglobulin therapy (2 g/kg), which was effective. He gradually recovered without major complications and was given ambulatory discharge 43 days after admission. Early diagnosis and administration of intensive care in adolescents with KD with acute myocarditis are critical but challenging.

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Immunomodulating and Immunosuppressive Therapy for Virus-Negative Immune-Mediated Myocarditis

Frustaci,

Letizia,

Alfarano

et al. 2024

Biomedicines

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Myocarditis is an inflammatory disease of the myocardium caused by infectious and noninfectious agents. Clinical manifestations range from mildly symptomatic forms to acute heart failure, cardiogenic shock, life-threatening arrhythmias and sudden death. Myocarditis is still a challenging diagnosis because of its wide variability in clinical presentation and unpredictable course. Moreover, a standardized, specific treatment in not yet available. Immunosuppressive treatment for virus-negative lymphocytic myocarditis is still controversial. Conversely, immunosuppression is well established in sarcoidosis, eosinophilic, giant-cell, drug hypersensitivity, and trauma-related myocarditis as well as lymphocytic myocarditis associated with connective tissue diseases or with the rejection of a transplanted heart. Recently, immunosuppressive therapy has been also recognized as an effective treatment in virus-negative inflammatory cardiomyopathy. The aim of this review is to underline the role of immunomodulating and immunosuppressive therapies in patients with immune-mediated myocarditis and illustrate the different treatment strategies depending on the etiology. An endomyocardial biopsy remains the gold standard for the diagnosis of myocarditis as well as for a tailored treatment.

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Myocarditis and intramural coronary vasculitis in polyarteritis nodosa: an unusual treatable form of heart failure

Cited by 3 publications

References 9 publications

Autoimmune Heart Disease: A Comprehensive Summary for Forensic Practice

Autoimmune Heart Disease: A Comprehensive Summary for Forensic Practice

Kawasaki disease with acute myocarditis in an adolescent

Immunomodulating and Immunosuppressive Therapy for Virus-Negative Immune-Mediated Myocarditis

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