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Case Reports in Cardiology
Volume 2015, Article ID 134529, 4 pages
http://dx.doi.org/10.1155/2015/134529
Case Report

Acute Myocarditis in a Patient with Newly Diagnosed Granulomatosis with Polyangiitis

1Department of Oncology, Aarhus University, Nørrebrogade 44, 8000 Aarhus C, Denmark
2Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
3Institute of Pathology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
4The Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, 5000 Odense C, Denmark

Received 10 September 2015; Accepted 18 November 2015

Academic Editor: Monvadi Barbara Srichai

Copyright © 2015 Anne Munch et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 22-year-old woman recently diagnosed with granulomatosis with polyangiitis (GPA) was admitted to the department of cardiology due to chest pain and shortness of breath. The ECG showed widespread mild PR-segment depression, upwardly convex ST-segment elevation, and T-wave inversion. The troponin T level was elevated at 550 ng/L. Transthoracic echocardiography showed basal inferoseptal thinning and hypokinesis, mild pericardial effusion, and an overall preserved left ventricular ejection fraction of 55%. Global longitudinal strain, however, was clearly reduced. Cardiac magnetic resonance imaging (MRI) showed findings consistent with myocarditis but the etiology of the apical hypokinesis could not be determined with certainty and may well have been due to a myocardial infarction, a notion supported by a coronary angiogram displaying slow flow in the territory of the left anterior descending artery. Finally, an endomyocardial biopsy confirmed the diagnosis of myocarditis. The cardiac symptoms subsided upon treatment with high-dose prednisolone and rituximab.