Myocarditis in Adult-Onset Still’s Disease: Case-Based Review

  • Abraham Edgar Gracia-RamosEmail author
  • Joshua Antonio Contreras-Ortíz
Case Based Review


Cardiac involvement in adult-onset Still’s disease (AOSD) usually manifests as a pericardial disease. Myocarditis is uncommon (prevalence of 7%). However, the cardiocirculatory failure is the second cause of life-threatening AOSD. Herein, we report the case of a 38-year-old man who was diagnosed with myocarditis caused by AOSD. He was treated medically with steroids and methotrexate, and his course was favorable. A literature search in PubMed/MEDLINE and Scopus databases from 1971 to 2019 identified 47 additional cases of myocarditis and AOSD. The main features found in these reports were reviewed and are the following: (i) myocarditis is a rare complication of AOSD manifested by fever, chest pain, dyspnea, and tachycardia; (ii) cardiac biomarkers, electrocardiogram (ECG), transthroracic echocardiography (ECHO), and cardiac magnetic resonance imaging (MRI) are useful noninvasive diagnostic tools; and (iii) myocarditis is a potentially life-threatening complication of AOSD but responds positively to steroids and other immunomodulatory drugs. This review suggests that this entity should be suspected in cases of acute febrile myocarditis after ruling out other causes since a prompt treatment results in a good prognosis.


Adult-onset Heart diseases Myocarditis Still’s Disease 


Authors’ contributions

The case was diagnosed and followed up by AEGR and JACO, and AEGR conceived and planned the case report. Material preparation, data collection, and analysis were performed by AEGR and JACO. AEGR wrote the initial draft of the manuscript. JACO revised and edited the manuscript. The final version was read, corrected, and approved by both authors, and both agree to be accountable for all aspects of the work.


The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards



Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent for publication has been obtained from the patient, in line with the COPE best practice guidelines.


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineGeneral Hospital, National Medical Center “La Raza”, Instituto Mexicano del Seguro SocialMexico CityMexico
  2. 2.Department of Internal MedicineHospital Regional de Alta Especialidad de ZumpangoZumpangoMexico
  3. 3.Service of RheumatologyHospital Regional de Alta Especialidad de ZumpangoZumpangoMexico

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