Acute myocarditis associated with adenoviral infection in a patient with scleroderma.
We describe a 40-year-old man with limited scleroderma who presented with acute heart failure following a flu-like illness. He was known to have incomplete left anterior bundle branch block, initial isolated pulmonary hypertension with enlarged right atrium, and no pulmonary fibrosis. He received therapy for acute heart failure and was transferred to a scleroderma centre for specific treatment of scleroderma cardiomyopathy. Investigations showed raised inflammatory markers and diffuse hyperechogenic thickening of the myocardium on echocardiography. Contrast-enhanced (Gd-DOTA) cardiovascular magnetic resonance imaging (CV-MRI) showed multiple areas of non-homogeneous delayed hyperenhancement in the left ventricle, suggestive of myocarditis. Antiadenovirus IgM antibodies were detected with a titer consistent with recent infection. Six weeks later a repeat Gd-DOTA CV-MRI showed an almost complete resolution of the areas of hyperenhancement and there was a significant reduction in the adenovirus antibody titer with serological conversion to IgG. To our knowledge this is the first report of viral myocarditis in scleroderma. Infections are important causes of morbidity and mortality in this disease and should always be included in the differential diagnosis of cardiac symptoms. We propose that contrast-enhanced CV-MRI is valuable in a non-invasive diagnosis of heart disease in patients with scleroderma.
Dziadzio
Magdalena
M
Istituto di Clinica Medica, Ematologia ed Immunologia Clinica, Università di Ancona, Ancona, Italy. m.dziadzio@rfc.ucl.ac.uk
Giovagnoni
Andrea
A
Pomponio
Giovanni
G
Recanatini
Andrea
A
della Costanza
Osmy Paci
OP
Manzin
Aldo
A
Casagrande
Walter
W
Gabrielli
Armando
A
D000208:Acute Disease; D000256:Adenoviridae / Q000302:isolation & purification*; D000257:Adenoviridae Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D003287:Contrast Media; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis*; D018570:Risk Assessment; D012595:Scleroderma, Systemic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D012720:Severity of Illness Index
D003287:Contrast Media