PMID- 31020177
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220408
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 2
IP  - 4
DP  - 2018 Dec
TI  - Refractory cardiac myocarditis associated with drug rash with eosinophilia and 
      systemic symptoms syndrome due to anti-bipolar disorder drugs: a case report.
PG  - yty100
LID - 10.1093/ehjcr/yty100 [doi]
LID - yty100
AB  - BACKGROUND: Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is 
      a severe adverse drug reaction accompanied by multiple organ dysfunction. 
      Myocarditis is a manifestation, and once acute necrotizing eosinophilic 
      myocarditis (ANEM) develops, the mortality rate is high. CASE SUMMARY: We report 
      the case of a 37-year-old man who developed myocarditis associated with DRESS 
      syndrome after starting treatment with lithium and quetiapine for bipolar 
      disorder. At that time, he presented with fever, morbilliform eruption, 
      lymphadenopathy, eosinophilia with atypical lymphocytes, and liver dysfunction; 
      bipolar drugs were discontinued and oral prednisolone begun. Four months later, 
      he was admitted to our institution with worsening skin rash and dyspnoea. 
      Transthoracic echocardiography revealed reduced systolic function in both 
      ventricles, and endocardial biopsy indicated hypersensitivity myocarditis. 
      Cardiac function was temporarily normalized by high-dose prednisolone. However, 
      the inflammation was persistent as shown by a re-elevation of troponin T and fall 
      of left ventricular ejection fraction several months later; in addition, 
      (18)F-fluoro-deoxyglucose positron emission tomography with chest computed 
      tomography (FDG-PET/CT) showed focal FDG uptake in the left ventricle. Despite 
      additional treatment with mycophenolate mofetil, the cardiac function 
      deteriorated further, and the patient eventually manifested refractory heart 
      failure classified as New York Heart Association (NYHA) Class III. Myocardial 
      biopsy showed myocyte necrosis associated with ANEM. DISCUSSION: This is the 
      first case report of DRESS-associated myocarditis due to treatment for bipolar 
      disorder. Although the pathophysiology remains incompletely understood, lithium 
      and/or quetiapine can induce refractory myocarditis in DRESS syndrome. Regular 
      measurements of troponin T and FDG-PET/CT are useful for assessing disease 
      progression in DRESS-associated myocarditis.
FAU - Hagiwara, Hikaru
AU  - Hagiwara H
AD  - Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of 
      Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Japan.
FAU - Fukushima, Arata
AU  - Fukushima A
AD  - Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of 
      Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Japan.
FAU - Iwano, Hiroyuki
AU  - Iwano H
AD  - Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of 
      Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Japan.
FAU - Anzai, Toshihisa
AU  - Anzai T
AD  - Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of 
      Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Japan.
LA  - eng
PT  - Case Reports
DEP - 20181010
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
PMC - PMC6426116
OTO - NOTNLM
OT  - Acute necrotizing eosinophilic myocarditis (ANEM)
OT  - Bipolar disorder
OT  - Case report
OT  - Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome
OT  - Heart failure
OT  - Lithium
OT  - Quetiapine
EDAT- 2019/04/26 06:00
MHDA- 2019/04/26 06:01
PMCR- 2018/10/10
CRDT- 2019/04/26 06:00
PHST- 2018/03/24 00:00 [received]
PHST- 2018/08/25 00:00 [accepted]
PHST- 2019/04/26 06:00 [entrez]
PHST- 2019/04/26 06:00 [pubmed]
PHST- 2019/04/26 06:01 [medline]
PHST- 2018/10/10 00:00 [pmc-release]
AID - yty100 [pii]
AID - 10.1093/ehjcr/yty100 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2018 Oct 10;2(4):yty100. doi: 10.1093/ehjcr/yty100. 
      eCollection 2018 Dec.