Relapsing-Remitting Perimyocarditis and Emerging Acute Myeloid Leukemia
Madeline B Zipperer-Giblin1, John I Bowman2, Nidhi Patel3
1Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA.
Background:
Perimyocarditis as an initial manifestation of acute myeloid leukemia (AML) is rare, with fewer than 5 contemporary cases reported.
Case Summary:
A 66-year-old man experienced 7 hospitalizations over 3 months for fever, elevated troponin, and inflammatory markers after Coxsackievirus B exposure. Initial cardiac magnetic resonance (CMR), infectious, and hematologic work-ups were unremarkable. Repeat CMR revealed biventricular dysfunction, new lateral wall late gadolinium enhancement, myocardial edema, and a circumferential pericardial effusion. Endomyocardial biopsy confirmed severe lymphocytic myocarditis. The patient failed 2 corticosteroid tapers but improved with colchicine, intravenous immunoglobulin, and anakinra. After cardiac recovery, peripheral blood and bone marrow evaluation revealed AML.
Discussion:
This case highlights a potential rare dual-etiology mechanism for perimyocarditis involving viral injury and AML-driven inflammatory activation.
Take-Home Message:
This case underscores the diagnostic value of serial CMR with biopsy, the role of interleukin-1 blockade and intravenous immunoglobulin in steroid refractory disease, and vigilance for emerging hematologic malignancy.
Insights
Perimyocarditis, inflammation of the heart lining and muscle, can be an early sign of acute myeloid leukemia (AML). This rare presentation highlights the need for vigilance in diagnosing hematologic malignancies.
Area of Science:
- Cardiology
- Hematology
- Oncology
Background:
- Perimyocarditis as an initial manifestation of acute myeloid leukemia (AML) is exceptionally rare.
- Fewer than five contemporary cases have been documented in medical literature.
Related Concept Videos
Myocarditis I: Introduction
Myocarditis II: Clinical Features and Diagnostic Tests
Rheumatic Heart Disease I: Introduction
Cardiomyopathy IV: Restrictive Cardiomyopathy
Myocarditis III: Medical Management

