title: Brief report: antisynthetase syndrome-associated myocarditis.
abstract: BACKGROUND
  The antisynthetase (AS) syndrome is characterized by autoimmune myopathy, interstitial lung disease, cutaneous involvement, arthritis, fever, and antibody specificity. We describe 2 patients with AS syndrome who also developed myocarditis, depressed biventricular function, and congestive heart failure.
  
  
  RESULTS
  Both patients were diagnosed with AS syndrome based on clinical manifestations, detection of serum AS antibodies, and myositis confirmation with the use of skeletal muscle magnetic resonance imaging and skeletal muscle biopsy. In addition, myocarditis resulting in heart failure was confirmed with the use of cardiac magnetic resonance imaging and from endomyocardial biopsy findings. After treatment for presumed AS syndrome-associated myocarditis, one patient recovered and the other patient died.
  
  
  CONCLUSIONS
  AS syndrome is a rare entity with morbidity and mortality typically attributed to myositis and lung involvement. This is the first report of AS syndrome-associated myocarditis leading to congestive heart failure in 2 patients. Given the potentially fatal consequences, myocarditis should be considered in patients with AS syndrome presenting with heart failure.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: ksharma8@jhmi.edu.
authors.forename: Kavita
authors.initials: K
authors.lastname: Sharma
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Orbai
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Dipan
authors.initials: D
authors.lastname: Desai
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Cingolani
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Marc K
authors.initials: MK
authors.lastname: Halushka
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Christopher-Stine
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Mammen
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Wu
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sammy
authors.initials: S
authors.lastname: Zakaria
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D001707:Biopsy, Needle; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007150:Immunohistochemistry; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D009206:Myocardium / Q000473:pathology; D009220:Myositis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D035583:Rare Diseases; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Antisynthetase syndrome; heart failure; myocarditis
references.citation: Arthritis Rheum. 2005 Aug;52(8):2433-8
references.pmid: 16052581
references.citation: Rheumatol Int. 2007 Jun;27(8):775-80
references.pmid: 17221173
references.citation: Int J Cardiol. 2011 May 5;148(3):261-70
references.pmid: 20826015
references.citation: Clin Cardiol. 1993 Nov;16(11):802-8
references.pmid: 8269658
references.citation: Immunol Res. 2013 Jul;56(2-3):362-70
references.pmid: 23572427
references.citation: Rheumatol Int. 2012 Mar;32(3):779-82
references.pmid: 20049454
references.citation: Arthritis Rheum. 2013 Feb;65(2):314-24
references.pmid: 23124935
references.citation: Curr Rheumatol Rep. 2008 Aug;10(4):333-40
references.pmid: 18662515
references.citation: Br J Rheumatol. 1988 Oct;27(5):399-402
references.pmid: 3179631
references.citation: Proc Natl Acad Sci U S A. 2005 May 3;102(18):6356-61
references.pmid: 15851690
references.citation: Semin Arthritis Rheum. 1986 Feb;15(3):168-78
references.pmid: 3515559
references.citation: J Exp Med. 2002 Sep 16;196(6):781-91
references.pmid: 12235211
references.citation: Rheumatology (Oxford). 2006 Oct;45 Suppl 4:iv18-21
references.pmid: 16980718
references.citation: Medicine (Baltimore). 1977 Jul;56(4):255-86
references.pmid: 327194
references.citation: Curr Opin Rheumatol. 2007 Nov;19(6):523-9
references.pmid: 17917530
references.citation: Rheumatology (Oxford). 2009 Jun;48(6):607-12
references.pmid: 19439503
references.citation: Rheumatology (Oxford). 2013 Jul;52(7):1336-8
references.pmid: 23620561
references.citation: Circulation. 1997 Jan 7;95(1):163-8
references.pmid: 8994432
references.citation: Arthritis Rheum. 2003 Aug;48(8):2285-93
references.pmid: 12905483
references.citation: Arthritis Rheum. 1991 Nov;34(11):1391-6
references.pmid: 1953817
references.citation: Arthritis Rheum. 1986 Nov;29(11):1365-70
references.pmid: 3022759
references.citation: Am J Respir Crit Care Med. 2001 Oct 1;164(7):1182-5
references.pmid: 11673206
references.citation: Lancet. 1986 Sep 13;2(8507):605-7
references.pmid: 2427902
references.citation: Medicine (Baltimore). 2006 Mar;85(2):111-127
references.pmid: 16609350
references.citation: Am J Cardiol. 1982 Nov;50(5):998-1006
references.pmid: 7137049
references.citation: Circulation. 2006 Feb 14;113(6):876-90
references.pmid: 16476862
references.citation: Rev Med Interne. 2005 Aug;26(8):673-5
references.pmid: 15927314
references.citation: Arthritis Rheum. 2009 Aug;60(8):2524-30
references.pmid: 19644880
references.citation: N Engl J Med. 1992 May 21;326(21):1380-4
references.pmid: 1472183
references.citation: JACC Cardiovasc Imaging. 2012 May;5(5):513-24
references.pmid: 22595159
references.citation: J Rheumatol. 2002 Apr;29(4):861-2
references.pmid: 11950039
references.citation: Hum Pathol. 1989 Mar;20(3):224-31
references.pmid: 2470663
references.citation: Ann N Y Acad Sci. 2010 Jan;1184:134-53
references.pmid: 20146695
references.citation: Arthritis Rheum. 1979 Oct;22(10):1088-92
references.pmid: 486220
references.citation: Arch Intern Med. 1984 Nov;144(11):2185-9
references.pmid: 6497519
references.citation: Nat Rev Rheumatol. 2011 May;7(5):297-306
references.pmid: 21468145
references.citation: Nat Rev Neurol. 2011 Jun 08;7(6):343-54
references.pmid: 21654717
references.citation: J Exp Med. 2005 Feb 21;201(4):591-601
references.pmid: 15728237
references.citation: J Autoimmun. 2007 Sep-Nov;29(2-3):174-86
references.pmid: 17826948
references.citation: J Am Coll Cardiol. 1997 Nov 1;30(5):1354-9
references.pmid: 9350939
references.citation: Am J Cardiol. 1978 Jun;41(7):1141-9
references.pmid: 665523
references.citation: JACC Cardiovasc Imaging. 2011 Dec;4(12):1324-5
references.pmid: 22172790
references.citation: Joint Bone Spine. 2009 Dec;76(6):715-7
references.pmid: 19945897
references.citation: Proc Natl Acad Sci U S A. 2000 Aug 1;97(16):9209-14
references.pmid: 10922072
references.citation: Circulation. 2011 Jul 19;124(3):e40-1
references.pmid: 21768547
references.citation: Rheumatol Int. 2009 Jul;29(9):989-94
references.pmid: 19266202
references.citation: Ann Rheum Dis. 2001 Feb;60(2):116-23
references.pmid: 11156543
references.citation: Rheum Dis Clin North Am. 2002 Nov;28(4):859-90, viii
references.pmid: 12506776
references.citation: Joint Bone Spine. 2009 Oct;76(5):575-6
references.pmid: 19464224
references.citation: Arthritis Rheum. 1983 May;26(5):604-11
references.pmid: 6405755
references.citation: N Engl J Med. 1989 Oct 19;321(16):1061-8
references.pmid: 2677721
references.citation: J Cardiovasc Med (Hagerstown). 2010 Dec;11(12):906-11
references.pmid: 20625308
references.citation: Am J Med. 1993 Jan;94(1):110-1
references.pmid: 8420288
references.citation: N Engl J Med. 1975 Feb 20;292(8):403-7
references.pmid: 1089199
references.citation: Curr Rheumatol Rep. 2011 Jun;13(3):175-81
references.pmid: 21455765
references.citation: Ann Rheum Dis. 2006 Feb;65(2):249-52
references.pmid: 16410529
references.citation: Int J Cardiol. 2013 Mar 20;164(1):e3-4
references.pmid: 23022085
references.citation: Clin Cardiol. 2012 Nov;35(11):686-91
references.pmid: 22847365
references.citation: Circulation. 2007 Nov 6;116(19):2216-33
references.pmid: 17959655
references.citation: Arthritis Rheum. 1996 Sep;39(9):1507-18
references.pmid: 8814062