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Acute myocarditis causing fatal ventricular arrhythmia in treated polymyositis
P G White1, M R Podgorski, T I McLeod
1Royal National Hospital for Rheumatic Diseases, Bath.
British Journal of Rheumatology
|October 1, 1988
Summary
Polymyositis treatment with immunosuppressants improved muscle strength but led to fatal inflammatory myocarditis. This case highlights myocarditis as a potential late complication, even with therapy.
Area of Science:
- Neurology
- Cardiology
- Immunology
Background:
- Polymyositis is an idiopathic inflammatory myopathy characterized by symmetrical proximal muscle weakness.
- Standard treatment involves immunosuppressive agents like corticosteroids and azathioprine.
- Cardiac involvement in polymyositis can occur but is often subclinical.
Observation:
- A patient with polymyositis showed clinical improvement with prednisolone and azathioprine.
- Skeletal muscle enzyme levels normalized, and muscle strength increased.
- After seven weeks, the patient experienced chest pain and fatal ventricular arrhythmias.
Findings:
- Autopsy revealed inflammatory myocarditis.
- Histological examination of skeletal muscle showed significant improvement.
- This suggests a disconnect between peripheral muscle response and cardiac pathology.
Implications:
- Inflammatory myocarditis can be a serious, late-onset complication of polymyositis.
- Immunosuppressive therapy may not prevent cardiac involvement.
- Close cardiac monitoring is crucial in polymyositis patients, even with apparent treatment success.