Long-term treatment of morphologically verified myocarditis: successes and probable errors. Case report

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Abstract

Diagnosis and treatment of myocarditis can be challenging, including determining indications for heart transplantation. We present a 6-year medical history of a 54 years old patient with severe morphologically verified viral-negative lymphocytic myocarditis and systemic manifestations (onset of hemorrhagic vasculitis) combined with moderate coronary atherosclerosis, which regressed according to repeated coronary angiography. For 5 years, the patient received immunosuppressive therapy with methylprednisolone and azathioprine with a significant improvement. Repeated relapses of atrial fibrillation required correction of basic therapy and plasmapheresis. The disease was complicated by thyrotoxicosis and multi-organ dysfunction; the autopsy showed persistent myocarditis activity. The myocarditis is a chronic condition and requires a review of the treatment strategy at each stage.

About the authors

Olga V. Blagova

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: blagovao@mail.ru
ORCID iD: 0000-0002-5253-793X

д-р мед. наук, проф. каф. факультетской терапии №1 Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Indira N. Alieva

Sechenov First Moscow State Medical University (Sechenov University)

Email: blagovao@mail.ru
ORCID iD: 0000-0002-3338-0762

канд. мед. наук, врач-кардиолог отделения кардиологии Факультетской терапевтической клиники им. В.Н. Виноградова

Russian Federation, Moscow

Victoria A. Kulikova

Sechenov First Moscow State Medical University (Sechenov University)

Email: blagovao@mail.ru
ORCID iD: 0000-0002-9255-5542

канд. мед. наук, ассистент каф. факультетской терапии №1 Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Alexander V. Nedostup

Sechenov First Moscow State Medical University (Sechenov University)

Email: blagovao@mail.ru
ORCID iD: 0000-0002-5426-3151

д-р мед. наук, проф., науч. сотр. НИО кардиологии

Russian Federation, Moscow

Evgeniya A. Kogan

Sechenov First Moscow State Medical University (Sechenov University)

Email: blagovao@mail.ru
ORCID iD: 0000-0002-1107-3753

д-р мед. наук, проф., зав. каф. патологической анатомии им. акад. А.И. Струкова Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Vsevolod P. Sedov

Sechenov First Moscow State Medical University (Sechenov University)

Email: blagovao@mail.ru
ORCID iD: 0000-0003-2326-9347

д-р мед. наук, проф., проф. каф. лучевой диагностики Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Dmitry A. Parfenov

Sechenov First Moscow State Medical University (Sechenov University)

Email: blagovao@mail.ru
ORCID iD: 0000-0003-4145-0158

канд. мед. наук, зав. отделением интенсивной терапии и реанимации №1 Университетской клинической больницы №1

Russian Federation, Moscow

Alexey N. Volovchenko

Sechenov First Moscow State Medical University (Sechenov University)

Email: blagovao@mail.ru
ORCID iD: 0000-0002-3220-3895

канд. мед. наук, врач – анестезиолог-реаниматолог отд-ния интенсивной терапии и реанимации №1 Университетской клинической больницы №1

Russian Federation, Moscow

Natalia D. Sarkisova

Sechenov First Moscow State Medical University (Sechenov University)

Email: blagovao@mail.ru
ORCID iD: 0000-0002-5979-1180

канд. мед. наук, зав. кардиологическим отделением Факультетской терапевтической клиники им. В.Н. Виноградова

Russian Federation, Moscow

References

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2. Fig.1.

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3. Fig. 2. Echocardiograms of patient K. at the first admission (October 2013, upper images) and a year after the start of basic therapy (lower images).

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4. Fig. 3. Morphological study of the myocardium of patient K.: endomyocardial biopsy of the right ventricle – RV (October 2013, upper images) and postmortem study of the LV (April 2019, lower images).

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5. Fig. 4. Immunohistochemical study of the myocardium of patient K.: endomyocardial biopsy of RV (October 2013, upper images) and postmortem study of LV (April 2019, lower images).

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