Transient severe conduction disturbances associated with ankylosing spondylitis

Area of Science:

• Cardiology
• Rheumatology
• Immunology

Background:

• Ankylosing spondylitis (AS) is a chronic inflammatory disease.
• Cardiac involvement in AS can include atrioventricular (AV) block.
• Human leukocyte antigen-B27 (HLA-B27) positivity is common in AS.

Observation:

• A 46-year-old male patient presented with advanced and complete atrioventricular block.
• The patient was diagnosed with HLA-B27-positive ankylosing spondylitis.
• He was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) for AS.

Findings:

• The severe atrioventricular block spontaneously improved and resolved after 3 months of NSAID therapy.
• Cardiac magnetic resonance imaging revealed transient myocardial high-intensity signals in the basal septum.
• The atrioventricular block was reversible, negating the need for a pacemaker.

Implications:

• This case suggests that cardiac manifestations of AS, such as AV block, can be reversible with appropriate treatment.
• NSAID therapy may play a role in managing AS-related cardiac complications.
• Further research is warranted to understand the mechanisms of AS-induced carditis and its response to therapy.