A rare mode of revelation of Wegener's granulomatosis: myocarditis associated with a fibroblastic endocarditis

• Published in: The Pan African medical journal Vol. 23; p. 133
• Main Authors: Arous, Salim, Bensahi, Ilham, Noureddine, Malika, Habbal, Rachida
• Format: Journal Article
• Language: French
• Published: Uganda 25-03-2016
• Subjects: Adrenal Cortex Hormones - therapeutic use; Echocardiography; Endocarditis - drug therapy; Endocarditis - etiology; Granulomatosis with Polyangiitis - diagnosis; Granulomatosis with Polyangiitis - drug therapy; Granulomatosis with Polyangiitis - physiopathology; Heart Failure - diagnosis; Humans; Immunosuppressive Agents - therapeutic use; Male; Middle Aged; Myocarditis - drug therapy; Myocarditis - etiology; Renal Dialysis - methods; Renal Insufficiency - etiology; Renal Insufficiency - therapy; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - drug therapy; Ventricular Dysfunction, Left - etiology; atrial flutter; fibroplastic endocarditis; myocarditis; Wegener's granulomatosis
• ISSN: 1937-8688
• DOI: 10.11604/pamj.2016.23.133.8323

We report, through this observation, a rare case of Wegener's disease revealed by myocarditis associated with fibroblastic endocarditis. The patient was initially admitted to hospital with global heart failure. The ECG showed atrial flutter rhythm disorder. Echocardiographic examination revealed non-dilated left ventricle with severe dysfunction and positive troponin dosage. Severe renal failure was discovered fortuitously and required hemodialysis. It was associated with an inflammatory anaemia confirmed by serum ferritin and myelogram. c-ANCA dosage was strongly positive, confirming the diagnosis. Chest CT scanning objectified right basal pneumonia. After starting appropriate treatment, including corticotherapy and immunosuppressive treatment, evolution was favorable with the normalization of left ventricular systolic function. Although obvious clinical cardiac events are rare, cardiac involvement in Wegener's disease is described, requiring rapid diagnostic orientation and rigorous knowledge of this serious disease.