Myocarditis as the first manifestation of eosinophilic granulomatosis with polyangiitis

Danijela Djordjević Radojković; Svetlana Apostolović; Miodrag Damjanović; Tomislav Kostić; Aleksandra Fejsa Levakov; Marko Dimitrijević; Ružica Janković Tomašević; Sonja Dakić; Nenad Božinović; Milena Pavićević

doi:10.2298/VSP230218026D

Danijela Djordjević Radojković University Clinical Center Niš, Cardiology Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Niš, Serbia
Svetlana Apostolović University Clinical Center Niš, Cardiology Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Niš, Serbia
Miodrag Damjanović University Clinical Center Niš, Cardiology Clinic, Niš, Serbia
Tomislav Kostić University Clinical Center Niš, Cardiology Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Niš, Serbia
Aleksandra Fejsa Levakov University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Novi Sad, Serbia
Marko Dimitrijević General Hospital Zaječar, Zaječar, Serbia
Ružica Janković Tomašević University Clinical Center Niš, Cardiology Clinic, Niš, Serbia
Sonja Dakić University Clinical Center Niš, Cardiology Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Niš, Serbia
Nenad Božinović University Clinical Center Niš, Cardiology Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Niš, Serbia
Milena Pavićević University Clinical Center Niš, Cardiology Clinic, Niš, Serbia

DOI: https://doi.org/10.2298/VSP230218026D

Ključne reči: dijagnoza, histološke tehnike, miokarditis, eozinofilija, angiitis, granulomatozni

Sažetak

Uvod. Miokarditis nije retka dijagnoza, ali njegova etiologija često ostaje nepoznata, jer zahteva obiman dijagnostički rad. Eozinofilna granulomatoza sa poliangiitisom (EGPA) ili Churg-Strauss-ov sindrom je vrlo retka sistemska bolest, čiju dijagnozu nije lako postaviti. Miokarditis u EGPA nije čest i obično se javlja u kasnim stadijumima bolesti. Prikaz bolesnika. Muškarac, starosti 22 godine, primljen je pod kliničkom slikom akutnog koronarnog sindroma. Koronarnom angiografijom isključeno je prisustvo stenoza na epikardnim koronarnim arterijama i postavljena je radna dijagnoza infarkta miokarda bez opstrukcije koronarnih arterija (myocardial infarction with non-obstructive coronary arteries – MINOCA). Potom su utvrđeni inflamatorni sindrom, eozinofilija i mnogobrojni simptomi i znaci sistemske bolesti. Dijagnostički rad uključio je obimna laboratorijska ispitivanja, kojima su isključeni infektivni agensi kao uzročnici. Zatim su urađena imunološka ispitivanja, kompjuterizovana tomografija grudnog koša, magnetna rezonanca (MR) srca i biopsija koštane srži, nosne sluznice i kože. Postavljena je dijagnoza mioperikarditisa, koja je potvrđena pomoću MR srca. Uzrok miokarditis – EGPA, je utvrđen tek nakon patohistološkog nalaza biopsije kože, što je omogućilo adekvatnu imunosupresivnu terapiju. Zaključak. Precizna dijagnoza bila je presudna za ispravno – kauzalno lečenje bolesnika, posebno zbog toga što mu je potrebna doživotna imunosupresivna terapija. Kako bi ovako kompleksni bolesnici dobili adekvatnu terapiju, neophodan je multidisciplinarni pristup i istrajnost u dijagnostici etiologije miokarditisa.

Biografija autora

Miodrag Damjanović, University Clinical Center Niš, Cardiology Clinic, Niš, Serbia

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