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A case of life-threatening valvulitis mimicking infective endocarditis in systemic juvenile idiopathic arthritis

Published online by Cambridge University Press:  15 April 2020

Kyung Jin Oh
Affiliation:
Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
Hye Won Kwon*
Affiliation:
Department of Pediatrics, Seoul National University Childrenʼs Hospital, Seoul, Korea
Sungkyu Cho
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
Jeong Wook Seo
Affiliation:
Department of Pathology, Seoul National University Hospital, Seoul, Korea
*
Author for correspondence: H. W. Kwon, Department of Pediatrics, Seoul National University Childrenʼs Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul03080, Korea. Tel: +82 2 2072 4306; Fax: +82 2 747 2471. E-mail: [email protected]

Abstract

Differential diagnosis of an intracardiac mass is difficult when detected only by echocardiography before a biopsy is completed. However, treatment cannot be postponed until the biopsy results are obtained. We report the case of a 12-year-old girl who presented with an intracardiac mass in the mitral valve mimicking infective endocarditis and severe mitral regurgitation. The mass was finally diagnosed as valvulitis associated with systemic juvenile idiopathic arthritis, which was complicated with macrophage activation syndrome. After careful exclusion of acute infectious disease, we started steroid pulse therapy and administered tocilizumab to treat the cytokine storm before performing the surgery. Finally, we performed mass excision and mitral valve replacement after immunosuppressant therapy.

Type
Brief Report
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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References

Thierry, S, Fautrel, B, Lemelle, I, Guillemin, F. Prevalence and incidence of juvenile idiopathic arthritis: a systematic review. Joint Bone Spine 2014; 81: 112117.CrossRefGoogle ScholarPubMed
Ravelli, A, Minoia, F, Davì, S, et al. 2016 Classification criteria for macrophage activation syndrome complicating systemic juvenile idiopathic arthritis: a European league against rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatol 2016; 68: 566576.CrossRefGoogle ScholarPubMed
Koca, B, Sahin, S, Adrovic, A, Barut, K, Kasapcopur, O. Cardiac involvement in juvenile idiopathic arthritis. Rheumatol Int 2017; 37: 137142.CrossRefGoogle ScholarPubMed
Minoia, F, Davì, S, Horne, A, et al.Clinical features, treatment, and outcome of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis: a multinational, multicenter study of 362 patients. Arthritis Rheumatol 2014; 66: 31603169.CrossRefGoogle ScholarPubMed
Lin, C-I, Yu, H-H, Lee, J-H, et al.Clinical analysis of macrophage activation syndrome in pediatric patients with autoimmune diseases. Clin Rheumatol 2012; 31: 12231230.CrossRefGoogle ScholarPubMed
Parodi, A, Davì, S, Pringe, AB, et al.Macrophage activation syndrome in juvenile systemic lupus erythematosus: a multinational multicenter study of thirty-eight patients. Arthritis Rheumatol 2009; 60: 33883399.CrossRefGoogle ScholarPubMed
Ravelli, A, Magni-Manzoni, S, Pistorio, A, et al.Preliminary diagnostic guidelines for macrophage activation syndrome complicating systemic juvenile idiopathic arthritis. J Pediatr 2005; 146: 598604.CrossRefGoogle ScholarPubMed
Mazzeffi, M, Reich, DL, Adams, DH, Fischer, GW. A mitral valve mass: tumor, thrombus, or vegetation? J Cardiothorac Vasc Anesth 2011; 25: 889890.CrossRefGoogle ScholarPubMed
Sedgwick, JF, Scalia, GM. Advanced echocardiography for the diagnosis and management of infective endocarditis. Contemporary Challenges in Endocarditis 2016: pp59. DOI: 10.5772/64800. Retrieved from: https://www.intechopen.com/books/contemporary-challenges-in-endocarditis/advanced-echocardiography-for-the-diagnosis-and-management-of-infective-endocarditis.CrossRefGoogle Scholar
Habib, G, Lancellotti, P, Antunes, MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: the task force for the management of infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36: 30753128.CrossRefGoogle Scholar
Bruce, CJ.Cardiac tumours: diagnosis and management. Heart 2011; 97: 151160.CrossRefGoogle ScholarPubMed
Caruso, F, Ventura, L, Viliani, D, Della Sala, SW. Massive mitral annular calcification mimicking intracardiac mass: multimodality approach to diagnosis. Radiol Case Rep 2018; 13: 376379.CrossRefGoogle Scholar
Mousavi, N, Cheezum, MK, Aghayev, A, et al.Assessment of cardiac masses by cardiac magnetic resonance imaging: histological correlation and clinical outcomes. J Am Heart Assoc 2019; 8: e007829.CrossRefGoogle ScholarPubMed