Abstract
Still’s disease is a subset of juvenile idiopathic arthritis (JIA) that usually presents with intermittent fever, rash, and arthritis. Extra-articular flares can occur several years after disease onset. We report two cases of adult Still’s disease with myocarditis after several years of being in remission. A 34-year-old Caucasian man with history of systemic juvenile arthritis in remission since age 13 was admitted in hospital with 10 days history of fever, odynophagia, and arthralgias. Chest X-ray and cardiac ultrasound showed cardiac enlargement. An endomyocardial biopsy revealed acute myocarditis. He was treated with methylprednisolone and intravenous gammaglobulin, with improvement of his general condition and cardiac parameters. A 16-year-old Caucasian male patient with history of systemic JIA in remission for the last 7 years was admitted with 7 days history of fever, odynophagia, arthralgias, and myalgias. Two days after admission, he developed chest pain and pericardial rubbing was found on examination. Cardiac ultrasound showed left ventricular dilatation with impaired systolic function, and posterior, inferior and apical-septal wall hypokinesia. Blood test showed elevated creatine phosphokinase levels. He was treated with IV methylprednisolone with normal follow-up cardiac ultrasound. Cardiac involvement in patients with systemic JIA can be the first symptom of disease reactivation, even after many years of disease remission.
References
Woo P (2006) Systemic juvenile idiopathic arthritis: diagnosis, management, and outcome. Nat Clin Pract Rheumatol 2:28–34. doi:10.1038/ncprheum0084
Ravelli A, Martini A (2007) Juvenile idiopathic arthritis. Lancet 369:767–778. doi:10.1016/S0140-6736(07)60363-8
Prieur AM, Bremard-Oury C, Griscelli C, Mozziconacci P (1984) Prognosis of the systemic forms of juvenile chronic arthritis. Apropos of 100 cases. Arch Fr Pediatr 41:91–97
Goldenberg J, Ferraz MB, Pessoa AP et al (1992) Symptomatic cardiac involvement in juvenile rheumatoid arthritis. Int J Cardiol 34:57–62. doi:10.1016/0167-5273(92)90082-E
Lietman PS, Bywaters EG (1963) Pericarditis in juvenile rheumatoid arthritis. Pediatrics 32:855–860
Bernstein B, Takahashi M, Hanson V (1974) Cardiac involvement in juvenile rheumatoid arthritis. J Pediatr 85:313–317. doi:10.1016/S0022-3476(74)80107-1
Feldman AM, McNamara D (2000) Myocarditis. N Engl J Med 343(19):1388–1398
Magnani JW, Dec GW (2006) Myocarditis: current trends in diagnosis and treatment. Circulation 113:876–890. doi:10.1161/CIRCULATIONAHA.105.584532
Vukman RB, Fay GJ (1981) Juvenile rheumatoid arthritis with pericardial tamponade in an adult. Arch Intern Med 141:1078–1079. doi:10.1001/archinte.141.8.1078
Yoshinaga H, Koike R, Maruyama T et al (1993) Still’s disease relapse with severe pneumonitis after prolonged remission. Intern Med 32:902–905. doi:10.2169/internalmedicine.32.902
Acknowledgments
The authors wish to thank Cecilia Pisoni MD for critical review and for their help in translating this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cavallasca, J.A., Vigliano, C.A., Perandones, C.E. et al. Myocarditis as a form of relapse in two patients with adult Still’s disease. Rheumatol Int 30, 1095–1097 (2010). https://doi.org/10.1007/s00296-009-1031-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-009-1031-3