Advertisement

The Indian Journal of Pediatrics

, Volume 86, Issue 9, pp 857–859 | Cite as

Fatal Myocarditis in an Adolescent Girl with Evolving Connective Tissue Disease

  • Bipin JoseEmail author
  • Dantis Emmanuel
  • Preethy Harrison
Clinical Brief
  • 38 Downloads

Abstract

Connective tissue diseases are rarely suspected and diagnosed in childhood and adolescence. Rarity of occurrence and poor disease acceptance among parents make them extremely difficult to treat in the early stages. An adolescent girl presented with features of pneumonia, was worked up and diagnosed as an evolving connective tissue disease. Her clinical characteristics did not fit into any specific disease. She was started on steroids and immunoglobulin as she had fulminant myocarditis with rapid downhill clinical course. High index of suspicion and aggressive immunosuppression can be life saving in exceptional situations even though a specific diagnosis cannot be ascertained.

Keywords

Myocarditis Connective tissue disease Children Gottron’s papules Raynaud’s 

Notes

Authors’ Contribution

BJ: Involved in patient care, review of literature and drafting the manuscript; DE and PH: Involved in patient care, critical review and drafting the manuscript. Dr. Maj Gen (Retd) MNG Nair, Senior Consultant and Lead Pediatrics, Rajagiri Hospital, Aluva, Kerala will act as guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest

None.

References

  1. 1.
    Tarvin SE, O’Neil KM. Systemic lupus erythematosus, Sjögren syndrome, and mixed connective tissue disease in children and adolescents. Pediatr Clin N Am. 2018;65:711–37.CrossRefGoogle Scholar
  2. 2.
    Vehe RK, Riskalla MM. Collagen vascular diseases: SLE, dermatomyositis, scleroderma, and MCTD. Pediatr Rev. 2018;39:501–15.CrossRefGoogle Scholar
  3. 3.
    Kim S, Kahn P, Robinson AB, et al. Childhood Arthritis and Rheumatology Research Alliance consensus clinical treatment plans for juvenile dermatomyositis with skin predominant disease. Pediatr Rheumatol Online J. 2017;15:1.Google Scholar
  4. 4.
    Schwartz T, Sanner H, Gjesdal O, Flatø B, Sjaastad I. In juvenile dermatomyositis, cardiac systolic dysfunction is present after long-term follow-up and is predicted by sustained early skin activity. Ann Rheum Dis. 2014;73:1805–10.CrossRefGoogle Scholar
  5. 5.
    Alarcón-Segovia D. Mixed connective tissue disease and overlap syndromes. Clin Dermatol. 1994;12:309–16.CrossRefGoogle Scholar
  6. 6.
    Tsai Y-Y, Yang Y-H, Yu H-H, Wang L-C, Lee J-H, Chiang B-L. Fifteen-year experience of pediatric-onset mixed connective tissue disease. Clin Rheumatol. 2010;29:53–8.CrossRefGoogle Scholar
  7. 7.
    Okura Y, Takezaki S, Yamazaki Y, Yamada M, Kobayashi I, Ariga T. Rapid progression to pulmonary arterial hypertension crisis associated with mixed connective tissue disease in an 11-year-old girl. Eur J Pediatr. 2013;172:1263–5.CrossRefGoogle Scholar
  8. 8.
    Suri V, Varma S, Joshi K, Malhotra P, Kumari S, Jain S. Lupus myocarditis: marked improvement in cardiac function after intravenous immunoglobulin therapy. Rheumatol Int. 2010;30:1503–5.CrossRefGoogle Scholar
  9. 9.
    Aytaç S, Batu ED, Ünal Ş, et al. Macrophage activation syndrome in children with systemic juvenile idiopathic arthritis and systemic lupus erythematosus. Rheumatol Int. 2016;36:1421–9.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  1. 1.Department of PediatricsRajagiri HospitalAluvaIndia
  2. 2.Department of Clinical Immunology and RheumatologyRajagiri HospitalAluvaIndia
  3. 3.Department of DermatologyRajagiri HospitalAluvaIndia

Personalised recommendations