Case Report

Myocarditis Concurrent with Sweet Syndrome: A Presentation of Acute Myeloid Leukemia

Table 1

Myocarditis/myopericarditis in AML patients.

Age/sexPresentationCardiac evaluationLeukemic evaluationTreatmentAuthor

37/FAcute exertional chest pain with radiation to arms.Negative coronary artery angiography. TTE: EF of 50–55% with hypokinetic right ventricle. Cardiac MRI: EF of 33% with signal changes consistent with myocarditis.AML “confirmed on bone marrow biopsy.”Myopericarditis: colchicine and NSAIDs.Snavely et al. [7]
ECG with ST elevations in leads I, aVL, V1, and V2 and PR elevation in lead AVR. Troponin elevated at 1.6 ng/mL.AML treatment not stated.
CBC showed WBC of 13.7 k/µL with 28% blasts, Hgb of 10.0 g/dL, and Plts 145 k/µL.

48/MAcute substernal chest pain. Febrile (103.4°F).Negative coronary artery angiography with an ejection fraction of 40–45%. There was mild hypokinesis in the midinferior and mid-anterolateral walls and no pericardial effusions. TTE revealed the same findings.Bone marrow biopsy: hypercellular marrow with diffuse mononuclear infiltrates with flow cytometry consistent with AML. FISH analysis was positive for t(6; 9) (p23; q34).Myopericarditis: colchicine 0.6 mg BID; ibuprofen 600 mg TIDAgrawal et al. [8]
ECG with ST segment elevation in leads I, II, aVL, and V5 with PR elevation and ST depression in aVR. Troponin-I was 14.8 ng/mL. CBC revealed hemoglobin of 10.8 g/dL, white cell count of 13,000/µL, 56% blasts, absolute neutrophil count of 1,430/µL, and platelet count of 83 × 103/µL.AML: 7 d cytarabine and 3 d idarubicin followed by salvage therapy with HIDAC and midostaurin.

62/MAcute chest pain. ECG with ST elevation in inferior leads. Troponin of 1.5 µg/L.TTE: normal biventricular function with inferolateral hypokinesia. Angiography: normal coronary arteries.Bone marrow biopsy: 47% blasts suggestive for AML.Myocarditis: anti-inflammatory therapy.De Lazzari et al. [9]
Cardiac MRI: cardiac dysfunction with areas of myocardial edema and late enhancement.AML: fludarabine, steroids, and cytarabine.

AML: acute myeloid leukemia; CBC: complete blood count; ECG: electrocardiogram; EF: ejection fraction; FISH: fluorescence in situ hybridization; Hgb: hemoglobin; HIDAC: high-dose cytarabine; Plts: platelets; TTE: transthoracic echocardiogram; WBC: white blood cells.