Skip to main content

Main menu

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • 50th Volume Reprints
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • JRheum Supplements
  • Services

User menu

  • My Cart
  • Log In

Search

  • Advanced search
The Journal of Rheumatology
  • JRheum Supplements
  • Services
  • My Cart
  • Log In
The Journal of Rheumatology

Advanced Search

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • 50th Volume Reprints
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • Follow Jrheum on BlueSky
  • Follow jrheum on Twitter
  • Visit jrheum on Facebook
  • Follow jrheum on LinkedIn
  • Follow jrheum on YouTube
  • Follow jrheum on Instagram
  • Follow jrheum on RSS
LetterLetter

Myopericarditis Revealing Giant Cell Arteritis in the Elderly

AURÉLIE DAUMAS, PASCAL ROSSI, ALEXIS JACQUIER and BRIGITTE GRANEL
The Journal of Rheumatology March 2012, 39 (3) 665-666; DOI: https://doi.org/10.3899/jrheum.110934
AURÉLIE DAUMAS
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
PASCAL ROSSI
MD, PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
ALEXIS JACQUIER
MD, PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
BRIGITTE GRANEL
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: bgranel@ap-hm.fr
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
PreviousNext
Loading

To the Editor:

We read with great interest the report by Pugnet, et al describing the case of acute myocarditis revealing giant cell arteritis (GCA) in an elderly patient1. We describe a new case of myopericarditis heralding GCA.

A 67-year-old man was admitted to the cardiology intensive care unit for acute precordial chest pain radiating in his jaw, associated with dyspnea. He recently experienced deterioration of his general health. His history included psoriasis and dyslipidemia treated with atorvastatin. No other cardiovascular risk factor was noted. Examination did not reveal any sign of cardiac insufficiency and was normal except for diffuse psoriasis lesions. Biological evaluations showed normal levels of cardiac troponin I but detected a high inflammatory process with fibrinogen at 8 g/l (normal < 4), C-reactive protein at 285 mg/l (normal < 10), and white blood cell count at 11.3 × 109/l. Electrocardiogram showed negative T waves in the lateral cardiac area. Echocardiography revealed a moderate pericardial effusion and left ventricle hypertrophy with normal systolic and diastolic left ventricular function. Due to normal biomarkers of cardiac injury and results of echocardiography, no coronarography was performed. Indeed, the diagnosis of myopericarditis was suspected and then confirmed by cardiac magnetic resonance imaging (MRI), which showed delayed gadolinium enhancement on the epicardial side of the lateral left ventricular wall, typical of acute myocarditis, and a moderate pericardial effusion (Figures 1A, 2A). Etiological research for myopericarditis, including viral, bacterial, and parasitic infections, and investigation for autoimmune diseases remained negative. A thoraco-abdominal computed tomography scan detected a thickening of the wall of the whole aorta. Positron emission tomography (PET) with 18 FDG showed a hypermetabolism of the thoracic and abdominal aorta extending to the subclavian arteries. Considered together, the large vessel inflammation, myopericarditis, the alterations of general health, and the biological inflammatory process occurring in a patient older than age 50 years strongly suggested the diagnosis of GCA, even in the absence of temporal signs. Finally, histopathological analysis of a temporal artery biopsy gave results typical of GCA. The clinical outcome was successful under treatment with steroids, with regression of biological inflammation, healing of the myopericarditis (Figures 1B, 2B), and decrease in metabolic activity of the aorta wall on PET scan. With 2 years of followup and under a very low dose of steroids, the patient remained in good health with complete normalization of cardiac MRI findings.

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Delayed enhanced cardiac magnetic resonance images in short axis view 5 min after injection of gadolinium 0.2 mmol/kg during the first week after the onset of pain (A) and 6 months later (B). In (A), myocardial enhancement is located in the epicardial border of the lateral wall of the left ventricle; in (B) the enhancement has disappeared.

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2.

Images in end-diastolic phase; during the first week after the onset of pain, pericardial effusion is clearly visible during the diagnosis (A) and disappears completely 6 months later (B).

GCA preferentially affects the external carotid artery and its branches, and more specifically the superficial temporal artery, which explains the usual clinical signs of the disease. Currently, cardiac manifestations are rarely described in the literature, as only 3 cases of GCA-related myopericarditis are reported1,2. Pericarditis without myocarditis has also been reported, as inaugural manifestation of GCA3,4. Steroids were effective in almost all these cases. In contrast to the case reported by Pugnet, et al1, temporal signs of GCA were missing in our case and those reported by Teixera, et al2. However, in the review by Bablekos, et al4 pericardial involvement in GCA was associated with classical temporal signs of the disease in two-thirds of the cases.

Currently cardiac MRI plays a key role in the diagnosis and management of myocarditis5,6. In the study by Mahrholdt, et al7 a good correlation was observed between the contrast enhancement on MRI images and the MRI-driven myocardial biopsies showing active inflammation, confirming that cardiac MRI is a valuable tool for evaluation and monitoring of myocarditis. Therefore, as cardiac MRI may provide an alternative method for diagnosis of myocarditis6, the standard Dallas pathological criteria for the definition for myocarditis are currently discussed due to the low sensitivity, lack of prognostic value, and the risks of biopsy5.

Physicians should consider pericarditis and myocarditis as possible manifestations of GCA in subjects over 50 years old, even in the absence of typical manifestations of temporal arteritis4,8. Further large studies are required to evaluate the frequency of pericarditis and/or myocarditis associated with GCA. We suggest that both electrocardiogram and echocardiography should be systematically performed when presentation includes GCA.

REFERENCES

  1. 1.↵
    1. Pugnet G,
    2. Pathak A,
    3. Dumonteil N,
    4. Arlet P,
    5. Sailler L
    . Giant cell arteritis as a cause of acute myocarditis in the elderly [letter]. J Rheumatol 2011;38:2497–8.
    OpenUrlFREE Full Text
  2. 2.↵
    1. Teixera A,
    2. Capitaine E,
    3. Congy F,
    4. Herson S,
    5. Cherin P
    . Atteinte myopéricardique au cours de la maladie de Horton. Rev Med Interne 2003;24:189–94.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Guindon A,
    2. Rossi P,
    3. Bagneres D,
    4. Aissi K,
    5. Demoux A-L,
    6. Bonin-Guillaume S,
    7. et al.
    La péricardite: une manifestation de la maladie de Horton. Rev Med Interne 2007;28:326–31.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Bablekos GD,
    2. Michaelides SA,
    3. Karachalios GN,
    4. Nicolaou IN,
    5. Batistatou AK,
    6. Charalabopoulos KA
    . Pericardial involvement as an atypical manifestation of giant cell arteritis: Report of a clinical case and literature review. Am J Med Sci 2006;332:198–204.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Cooper LT Jr.
    . Myocarditis. N Engl J Med 2009;360:1526–38.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Friedrich MG,
    2. Sechtem U,
    3. Schulz-Menger J,
    4. Holmvang G,
    5. Alakija P,
    6. Cooper LT,
    7. et al;
    8. International Consensus Group on Cardiovascular Magnetic Resonance in Myocarditis
    . Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol 2009;53:1475–87.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Mahrholdt H,
    2. Goedecke C,
    3. Wagner A,
    4. Meinhardt G,
    5. Athanasiadis A,
    6. Vogelsberg H,
    7. et al.
    Cardiovascular magnetic resonance assessment of human myocarditis: A comparison to histology and molecular pathology. Circulation 2004;109:1250–8.
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    1. Granel B,
    2. Serratrice J,
    3. Rey J,
    4. Pache X,
    5. Swiader L,
    6. Habib G
    . La péricardite idiopathique chronique ou récidivante est-elle une maladie inflammatoire autonome? Rev Med Interne 2001;22:1204–12.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

The Journal of Rheumatology
Vol. 39, Issue 3
1 Mar 2012
  • Table of Contents
  • Table of Contents (PDF)
  • Index by Author
  • Editorial Board (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about The Journal of Rheumatology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Myopericarditis Revealing Giant Cell Arteritis in the Elderly
(Your Name) has forwarded a page to you from The Journal of Rheumatology
(Your Name) thought you would like to see this page from the The Journal of Rheumatology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Myopericarditis Revealing Giant Cell Arteritis in the Elderly
AURÉLIE DAUMAS, PASCAL ROSSI, ALEXIS JACQUIER, BRIGITTE GRANEL
The Journal of Rheumatology Mar 2012, 39 (3) 665-666; DOI: 10.3899/jrheum.110934

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

 Request Permissions

Share
Myopericarditis Revealing Giant Cell Arteritis in the Elderly
AURÉLIE DAUMAS, PASCAL ROSSI, ALEXIS JACQUIER, BRIGITTE GRANEL
The Journal of Rheumatology Mar 2012, 39 (3) 665-666; DOI: 10.3899/jrheum.110934
del.icio.us logo Twitter logo Facebook logo  logo Mendeley logo
  • Tweet Widget
  •  logo
Bookmark this article

Jump to section

  • Article
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Herpes Zoster Vaccine and Rheumatoid Arthritis
  • Seasonal Variations and Their Influence on Antineutrophil Cytoplasmic Antibody–Associated Vasculitis Relapse
  • Survival After Lung Transplantation in Patients With Rheumatoid Arthritis-Associated Lung Disease
Show more Letters

Similar Articles

Content

  • First Release
  • Current
  • Archives
  • Collections
  • Audiovisual Rheum
  • COVID-19 and Rheumatology

Resources

  • Guide for Authors
  • Submit Manuscript
  • Author Payment
  • Reviewers
  • Advertisers
  • Classified Ads
  • Reprints and Translations
  • Permissions
  • Meetings
  • FAQ
  • Policies

Subscribers

  • Subscription Information
  • Purchase Subscription
  • Your Account
  • Terms and Conditions

More

  • About Us
  • Contact Us
  • My Alerts
  • My Folders
  • Privacy/GDPR Policy
  • RSS Feeds
The Journal of Rheumatology
The content of this site is intended for health care professionals.
Copyright © 2025 by The Journal of Rheumatology Publishing Co. Ltd.
Print ISSN: 0315-162X; Online ISSN: 1499-2752
Powered by HighWire