title: Giant cell myocarditis in a patient with a spondyloarthropathy after a drug hypersensitivity reaction.
abstract: A young woman thought to have seronegative rheumatoid arthritis developed Stevens-Johnson syndrome after treatment with sulfasalazine; this resolved with prednisone. Later she was found to be HLA-B27-positive in keeping with a spondyloarthropathy. Soon afterward, she developed clinical myopericarditis and cardiogenic shock that responded initially to methylprednisolone and intravenous immunoglobulin, but recurred. An endomyocardial biopsy demonstrated active myocarditis with a mixed cell composition including rare giant cells, but not enough to classify it as giant cell myocarditis. Heart failure symptoms returned and she eventually required a heart transplant; the explanted heart showed giant cell myocarditis.
authors.affiliation: Divisions of Cardiology, Cardiac Surgery and Nursing, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mitoff
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Mesana
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Mielniczuk
authors.forename: Jackie
authors.initials: J
authors.lastname: Grenon
authors.forename: John P
authors.initials: JP
authors.lastname: Veinot
authors.forename: Leslie T
authors.initials: LT
authors.lastname: Cooper
authors.forename: Ross A
authors.initials: RA
authors.lastname: Davies
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001706:Biopsy; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000276:immunology; D004452:Echocardiography; D005260:Female; D015726:Giant Cells / Q000473:pathology; D015796:HLA-B27 Antigen / Q000276:immunology; D016027:Heart Transplantation; D006801:Humans; D009205:Myocarditis / Q000209:etiology* / Q000601:surgery; D025242:Spondylarthropathies / Q000188:drug therapy / Q000209:etiology*; D013262:Stevens-Johnson Syndrome / Q000139:chemically induced* / Q000188:drug therapy; D012460:Sulfasalazine / Q000009:adverse effects*
chemical_list: D018501:Antirheumatic Agents; D015796:HLA-B27 Antigen; D012460:Sulfasalazine