Recurrent Fulminant Myocarditis Accompanied by Lymphoid Follicle Formation in Myocardium

• Published in: Internal Medicine Vol. 59; no. 23; pp. 3045 - 3049
• Main Authors: Omatsu, Takashi, Hayashi, Takaharu, Ichibori, Yasuhiro, Makino, Nobuhiko, Hirata, Akio, Yasumura, Yoshio, Hirayama, Atsushi, Higuchi, Yoshiharu
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.12.2020; Japan Science and Technology Agency
• Subjects: Aged; Case Report; ectopic lymphoid follicles; Heart diseases; Humans; Immunosuppressive agents; immunosuppressive therapy; Immunotherapy - methods; Inflammation; Internal medicine; Male; Myocarditis; Myocarditis - complications; Myocarditis - physiopathology; Myocarditis - therapy; Myocardium; Myocardium - pathology; Recurrence; Sarcoidosis; Tertiary Lymphoid Structures - etiology; Tertiary Lymphoid Structures - physiopathology; Tertiary Lymphoid Structures - therapy; Treatment Outcome; immunosuppressive therapy; recurrence; ectopic lymphoid follicles; myocarditis
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.5268-20

A 76-year-old man developed repeated fulminant myocarditis in a short period, and immunosuppressive therapy was remarkably effective. A pathologic evaluation showed that inflammatory cells had infiltrated the myocardium. Not only invasion of inflammatory cells but also the formation of lymphoid follicle was noted. Chronic myocardial inflammation was proven, but cardiac sarcoidosis was negative according to the results of various examinations. This is the first report of recurrent autoimmune myocarditis with a lymphoid follicle in the myocardium. These findings may suggest a novel pathogenesis of myocarditis.