University therapeutic journal

Drug-associated myocarditis: focus on cardiac imaging methods of diagnostics and features of treatment tactics on the example of a clinical case

  • Anton V. Barsukov JSC “KardioKlinika”. 25 Kuznetsovskaya str., Saint Petersburg 196105 Russian Federation https://orcid.org/0000-0002-1943-9545
  • Ekaterina V. Borisova JSC “KardioKlinika”. 25 Kuznetsovskaya str., Saint Petersburg 196105 Russian Federation
  • Svetlana A. Glebova JSC “KardioKlinika”. 25 Kuznetsovskaya str., Saint Petersburg 196105 Russian Federation
  • Armen V. Airapetyan JSC “KardioKlinika”. 25 Kuznetsovskaya str., Saint Petersburg 196105 Russian Federation
  • Alisa E. Sedova Pavlov First Saint Petersburg State Medical University. 6–8 L’va Tolstogo str., Saint Petersburg 197022 Russian Federation
  • Maxim V. Lukin JSC “KardioKlinika”. 25 Kuznetsovskaya str., Saint Petersburg 196105 Russian Federation
Keywords:
лекарственно-ассоциированный миокардит гиперчувстви­тельность токсичность сердечная недостаточность натрийуретический пептид эхокардиография магнитно-резонансная томография дифференциальный диагноз квадротерапия положительная динамика drug-associated myocarditis hypersensitivity toxicity heart failure natriuretic peptide echocardiography magnetic resonance imaging differential diagnosis quadruple therapy positive dynamics

Abstract

Drug toxicity and hypersensitivity are underestimated etiopathogenetic factors of myocardial damage. The list of pharmacological agents associated with the development of myocarditis is significant. Drug-associated myocarditis has a wide range of clinical manifestations and course trajectories. In one third of patients, the latent period after exposure to the causative drug before the development of myocarditis is 2–2.5 months. Heart failure is the dominant syndrome. Ultrasound and magnetic resonance imaging are the main diagnostic methods for clarifying the substrate of clinical manifestations. The presence of heart failure with a low ejection fraction (HFrEF) in individuals with drug-associated myocarditis suggests the use of conventional quadruple therapy, which has pathogenetic and prognostic significance. The article is based on a clinical case reflecting the difficulties of differential diagnosis, the possibilities of modern cardiac imaging and genetic diagnostic methods, as well as the success of treatment tactics for antibiotic-associated myocarditis occurring with HFrEF.

References

Арутюнов Г.П., Палеев Ф.Н., Моисеева О.М. и др. Миокардиты у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2021;26(11):4790. DOI: 10.15829/1560-4071-2021-4790.

Барсуков А.В., Медведев В.М., Куренкова И.Г. Некоронарогенные заболевания миокарда. Учебное пособие. Под редакцией С.Б. Шустова. СПб.: ­ЭЛБИ-СПб; 2008.

Ammirati E., Frigerio M., Adler E.D. et al. Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document. Circ. Heart Fail. 2020;13:e007405. DOI:10.1161/CIRCHEARTFAILURE.120.007405.

Fu M., Kontogeorgos S., Thunström E. et al. Trends in myocarditis incidence, complications and mortality in Sweden from 2000 to 2014. Sci. Rep. 2022;12:1810. DOI: 10.1038/s41598-022-05951-z.

Fairweather D., Beetler D.J., Musigk N. et al. Sex and gender differences in myocarditis and dila­ted cardiomyopathy: An update. Front. ­Cardio­vasc. Med. 2023;10:1129348. DOI: 10.3389/fcvm.2023.1129348.

Golpour A., Patriki D., Hanson P.J. et al. Epidemiolo­gical Impact of Myocarditis. J. Clin. Med. 2021;10:603. DOI: 10.3390/jcm10040603.

Nguyen L.S., Cooper L.T., Kerneis M. et al. Syste­matic analysis of drug-associated myocarditis reported in the World Health Organization pharmacovigilan­ce database. Nat Commun. 2022;13(1):25. DOI: 10.1038/s41467-021-27631-8.

Lasica R., Djukanovic L., Savic L. et al. Update on Myocarditis: From Etiology and Clinical Picture to Modern Diagnostics and Methods of Treatment. Dia­gnostics (Basel). 2023;13(19):3073. DOI: 10.3390/diagnostics13193073.

Bourgeois G.P., Cafardi J.A., Groysman V. et al. A review of DRESS-associated myocarditis. J. Am. Acad. Dermatol. 2012;66(6):e229-36. DOI: 10.1016/j.jaad.2010.11.057.

Morimoto S., Kubo N., Hiramitsu S. et al. Changes in the peripheral eosinophil count in patients with acute eosinophilic myocarditis. Heart Vessels. 2003;18:193–196. DOI: 10.1007/s00380-003-0721-0.

Ang C.C., Wang Y.S., Yoosuff E.L. et al. Retrospective analysis of drug-induced hypersensitivity syndrome: A study of 27 patients. J. Am. Acad. Derma­tol. 2010;63:219–227. DOI: 10.1016/j.jaad.2009.08.050.

Radovanovic M., Jevtic D., Calvin A.D. et al. Heart in DRESS: Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophi­lia and Systemic Symptoms Syndrome: A Systematic Review. J. Clin. Med. 2022;11:704. DOI: 10.3390/jcm11030704.

Барсуков А.В., Глуховской Д.В. Острый вирусный миокардит: от диагноза к лечению. Клиническая патофизиология. 2017;2:41–50.

Просвирнина М.С., Даниленко Л.А., Шмонин А.А., Бутко Д.Ю. Методы оценки толерантности к физической нагрузке у детей. University Therapeutic Journal. 2023;5(2):39–56.

Мамиев Н.Д., Василенко В.С. Влияние методов криотерапии и абдоминальной декомпрессии на эффективность восстановления у подростков спортс­менов. Children’s Medicine of the North-West. 2021;9(1):243–244.

Давыдов А.Т., Петрова Н.Н., Литвинцев С.В., Бутко Д.Ю., Стрельников А.А. Современные антидепрессанты, их роль и место в психиатрической и общемедицинской практике. Обзоры по клинической фармакологии и лекарственной терапии. 2007;5(2):49–62.

Балукова Е.В., Успенский Ю.П., Фоминых Ю.А. Поражения печени различного генеза (токсического, лекарственного, дисметаболического): от этиологической гетерогенности к единой унифицированной терапии пациентов). РМЖ. Медицинское обозрение. 2018;2(1-1):35–40.

Искра Д.А., Бутко Д.Ю. Уридин и уридинсодержащие комплексы при неспецифической боли в спине. От патогенеза к лечению. Нервные болезни. 2020;4:20–24.

How to Cite
Drug-associated myocarditis: focus on cardiac imaging methods of diagnostics and features of treatment tactics on the example of a clinical case. (2025). University Therapeutic Journal, 7(3), 123-133. https://doi.org/10.56871/UTJ.2025.26.92.014
Issue
Vol. 7 No. 3 (2025)
Section
Clinical case
Published
2025-10-09

How to Cite

Drug-associated myocarditis: focus on cardiac imaging methods of diagnostics and features of treatment tactics on the example of a clinical case. (2025). University Therapeutic Journal, 7(3), 123-133. https://doi.org/10.56871/UTJ.2025.26.92.014