Related Experiment Video
Updated: May 16, 2026

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Endocardial and myocardial involvement in systemic sclerosis--is there a relevant inflammatory component?
Robert Dinser1, Marc Frerix, Florian M P Meier
1Department of Internal Medicine and Rheumatology, Justus-Liebig-University of Giessen, Kerckhoff-Klinik, Rheumatology and Clinical Immunology, Benekestr 2-8, 61231 Bad Nauheim, Germany.
Objectives:
Myocardial manifestations of systemic sclerosis are mainly due to fibrotic remodeling. We report on two cases, where an endocardial and myocardial inflammation may be a relevant component of cardiac disease.
Case Series:
Case 1 presented with fulminant tricuspid failure in the absence of pulmonary hypertension and with newly developing systemic sclerosis. Myocardial biopsy and MRI supported endocardial and myocardial inflammation. Treatment with cyclophosphamide resulted in stabilization of cardiac function and normalization of cardiac enzymes. The patient died due to infectious complications. Case 2, also newly developed systemic sclerosis, presented with renal crisis and pulmonary alveolitis. Elevated cardiac troponin T persisted in the presence of cyclophosphamide treatment, subsequent MRI suggested myocardial inflammation. After stepping up treatment by addition of rituximab cardiac enzymes normalized and cardiac function stabilized.
Conclusion:
We hypothesize that low-grade endocardial and myocardial inflammation may be more relevant in systemic sclerosis than appreciated previously.
Related Concept Videos
Myocarditis I: Introduction
Rheumatic Heart Disease I: Introduction
Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
Endocarditis II: Clinical Features of Infective Endocarditis
Myocarditis II: Clinical Features and Diagnostic Tests
Cardiomyopathy IV: Restrictive Cardiomyopathy
