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Recurrent Myocarditis Treated with Intravenous Immune Globulin and Steroids.
Schwartz, Brandon H; Stein, Nathan R; Eshaghian, Shervin; Kwan, Alan C; Kittleson, Michelle M.
  • Schwartz BH; Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
  • Stein NR; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
  • Eshaghian S; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
  • Kwan AC; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
  • Kittleson MM; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Am J Case Rep ; 23: e935974, 2022 Jul 08.
Article in English | MEDLINE | ID: covidwho-1924685
ABSTRACT
BACKGROUND Myocarditis is an inflammatory process that can present as acute or chronic with either focal or diffuse involvement of the myocardium. Its incidence is approximately 1.5 million cases per year worldwide. In the United States, viral infection is the most common cause of myocarditis. Most of the reported cases are singular and self-limiting in nature. We present the case of severe recurrent myocarditis in a young adult who was transferred to the Intensive Care Unit. CASE REPORT An 18-year-old man presented with chest pressure and troponin I 33 ng/mL. He had presented to another hospital with similar symptoms 3 months prior and was diagnosed with myocarditis that had resolved with colchicine. As part of his workup during this admission, coronary angiogram was normal and biopsy obtained without evidence of an inflammatory process; however, cardiac magnetic resonance imaging (MRI) was consistent with myocarditis and Coxsackie B titers indicated prior infection, leading to a diagnosis of clinically suspected recurrent viral myocarditis. He was treated with intravenous immunoglobulin (IV Ig) and a steroid taper, with rapid improvement in symptoms over the ensuing weeks without evidence of further recurrence or sequelae. CONCLUSIONS We present a case of recurrent Coxsackie B myocarditis based on presentation and imaging. Myocarditis is an important diagnosis to consider when a young, healthy individual presents with chest pain mimicking acute coronary syndrome, especially during the COVID pandemic. If there is evidence of myocarditis on MRI or endomyocardial biopsy, immunosuppressive therapy should be considered in patients with recurrent and severe presentations.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Coxsackievirus Infections / COVID-19 / Myocarditis Type of study: Case report / Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Adolescent / Humans / Male Language: English Journal: Am J Case Rep Year: 2022 Document Type: Article Affiliation country: Ajcr.935974

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Coxsackievirus Infections / COVID-19 / Myocarditis Type of study: Case report / Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Adolescent / Humans / Male Language: English Journal: Am J Case Rep Year: 2022 Document Type: Article Affiliation country: Ajcr.935974