An extensive primary myocardial fibrosis in progressive systemic sclerosis--a case report with autopsy findings

An extensive myocardial fibrosis due to progressive systemic sclerosis (PSS) was described in a 36-year-old normotensive woman without pulmonary hypertension. An electrocardiogram showed low voltage and a pseudo-infarctional pattern in leads V1 through V3. Right ventricular dilatation and generalized left ventricular hypokinesis were present, but her pulmonary artery pressure was normal. Serum creatine kinase (CK) was elevated to 2305 U/L and CK-MB isoenzyme was as high as 7.1%. Simultaneously performed isoenzyme analysis of CK from the homogenate of the skeletal muscle of the patient showed a similar pattern, thus confirming that serum CK originated mainly from the skeletal muscle lesions. Autopsy findings demonstrated diffuse myocardial fibrosis and relatively unremarkable changes in the lungs and the kidneys. Our case serves as a warning that primary myocardial fibrosis could be, in some cases, so extensive that it might lead to a rapidly aggravated myocardial dysfunction and eventual death.