Table 1 Clinical presentation, CMR findings, and treatment of recurrent myocarditis and pericarditis
Variables | February 2016 | December 2017 | May 2019 | April 2021 |
|---|---|---|---|---|
Signs and Symptoms | Diarrhea, abdominal pain, fever, myalgias, joint pain, and sudden sharp chest pain | Fever, arthralgias, and stabbing chest pain | Recurrent stabbing chest pain (10/10) and myalgias | Abdominal pain, cramps, diarrhea, and recurrent severe pleuritic chest pain. |
Last of symptoms | 4 | 3 | 5 | 2 |
ECG findings | Extensive ST elevation (Fig. 1A) | Extensive ST-depression and T wave inversion V1-V2 (Fig. 1B) | Extensive ST-depression | Normal ECG. (Fig. 1C) |
CMR findings | Mild LV dilation, LVEF 44%, LVGLS − 22.19%, anterolateral and anteroseptal myocardial edema, and anterolateral subepicardial LGE. | LVEF 60%, LVGLS − 20.07%, inferolateral and inferoseptal myocardial edema, same subepicardial LGE. | LVEF 58%, LVGLS − 17.03%, myocardial lateral wall edema, mid-wall lateral LV, and inferior RV free wall LGE. | LVEF 57%, LVGLS − 12.61%, reduced reservoir left atrial strain (-22.25%) and conduit left atrial strain (-14.0%), pericardial LGE areas (anterior, inferior, and lateral myocardial walls). |
US-CRP (mg/dL) | 8.48 | 8.14 | 4.42 | 5.51 |
CD4+/CD8 + T Cell Ratio | ----- | ----- | ----- | 1.02 |
scTn > 0.05 ng/mL | 6.15 | 1.06 | ----- | ----- |
hs-cTnI (ng/L) | ----- | ----- | 11416.8 | 805.1 |
BNP (pg/mL) | 63.8 | 16.1 | < 10 | 30.1 |
D-dimer (ng/mL) | 192 | ND | ND | ND |
Treatment | Aspirin 100 mg PO QD Carvedilol 6.25 mg PO BID Candesartan 8 mg PO QD | Colchicine 0.5 mg PO BID Ibuprofen 800 mg PO TID Morphine Sulphate 2.5 mg IV | Colchicine 0.5 mg PO QD Indomethacin 50 mg PO TID Metoprolol succinate 95 mg ¼ QD Morphine Sulphate 5 mg IV | Colchicine 0.5 mg PO BID Ibuprofen 800 mg PO TID |