Cardiology Letters 2025, 34(3):182-185

Acute myocarditis in patient with IgG4-related disease

Samuel Nachtmann, Tomas Koller, Martin Jankovsky, Yashar Jalali, Juraj Payer

5th Department of Internal Medicine of the Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia

We present case of 27-year-old woman in the chronic care of her gastroenterologist for IgG4-related disease, with pancreatitis, cholangitis, colitis, and perimyocarditis in the past. Now in long-term remission on combination therapy with budesonide and biological therapy with rituximab, she was admitted to our Intensive care unit (ICU) for chest pain and dyspnoea with increased frequency of stools. She did not present with any remarkable findings during physical examination and she was hemodynamically stable, without requiring oxygen. Laboratory findings showed leukocytosis with neutrophilia, elevated CRP (C-reactive protein) without PCT (procalcitonin), slightly elevated Troponin (hs-cTnT) without typical dynamic for acute coronary syndrome, and high NTproBNP (N-terminal prohormone of brain natriuretic peptide). We performed transthoracic echocardiography showing preserved left ventricular systolic function, localized hypokinesia, and reduction of the longitudinal strain of the basal segment of the interventricular septum. With her history of allergy to gadolinium, CT coronarography was done that showed small pericardial effusion, without pericardial thickening, and calcifications and stenosis of coronary arteries. Abdominal ultrasound showed non-homogenous structure of the pancreas, cholecystolithiasis, solid-cystic lesion of the right adrenal gland, and thickened wall of the colon. After these results we decided to add PET/CT scan, which showed diffuse activity of bone marrow, right adrenal gland expansion with low activity, and colitis without any findings of malignancy or inflammation. We concluded the condition as acute myocarditis associated with the IgG4-related disease. She was then treated with oral prednisone with good effect and was discharged after 13 days.

Keywords: IgG4-related disease; acute cardiac injury; myocarditis; cardiac markers

Published: March 1, 2025  Show citation