Fulminant myocarditis in polymyositis

Cardiac involvement in patients with polymyositis is usually asymptomatic a nd associated with a mild clinical course. A female patient with muscle wea kness and cardiogenic shock, who was diagnosed with polymyositis and fulmin ant myocarditis, is described. A large amount of methylprednisolone, in add ition to intra-aortic balloon pumping and percutaneous cardiopulmonary supp ort, led to the recovery of her cardiac function. However, a massive cerebr al embolism occurred and she died. Postmortem histopathological examination showed necroses of muscles and diffuse invasion of mononuclear cells in bo th the myocardium and the biceps muscle of her arm. Although the mechanism of cardiac dysfunction is not clear, immunosuppressive therapy was effectiv e for fulminant myocarditis in the present case.