Key result
Colchicine, IVIG, and anakinra drive cardiac recovery in steroid-refractory perimyocarditis preceding acute myeloid leukemia.
Why the study?
Perimyocarditis as an initial manifestation of acute myeloid leukemia is rare, with fewer than 5 contemporary cases reported.
Case Report (n=1)
This case underscores the diagnostic value of serial CMR with biopsy, the role of interleukin-1 blockade and intravenous immunoglobulin in steroid-refractory perimyocarditis, and vigilance for emerging hematologic malignancy.
May prompt hematologic evaluation in recurrent perimyocarditis; extends sparse reports but leaves open systematic screening.
BACKGROUND: Perimyocarditis as an initial manifestation of acute myeloid leukemia (AML) is rare, with fewer than 5 contemporary cases reported. CASE SUMMARY: A 66-year-old man experienced 7 hospitalizations over 3 months for fever, elevated troponin, and inflammatory markers after Coxsackievirus B exposure. Initial cardiac magnetic resonance (CMR), infectious, and hematologic work-ups were unremarkable. Repeat CMR revealed biventricular dysfunction, new lateral wall late gadolinium enhancement, myocardial edema, and a circumferential pericardial effusion. Endomyocardial biopsy confirmed severe lymphocytic myocarditis. The patient failed 2 corticosteroid tapers but improved with colchicine, intravenous immunoglobulin, and anakinra. After cardiac recovery, peripheral blood and bone marrow evaluation revealed AML. DISCUSSION: This case highlights a potential rare dual-etiology mechanism for perimyocarditis involving viral injury and AML-driven inflammatory activation. TAKE-HOME MESSAGE: This case underscores the diagnostic value of serial CMR with biopsy, the role of interleukin-1 blockade and intravenous immunoglobulin in steroid refractory disease, and vigilance for emerging hematologic malignancy.
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Zipperer-Giblin et al. (2026) conducted a case report in Perimyocarditis and Acute Myeloid Leukemia (n=1). Colchicine, intravenous immunoglobulin, and anakinra was evaluated. Treatment with colchicine, intravenous immunoglobulin, and anakinra led to cardiac recovery in a 66-year-old man with steroid-refractory perimyocarditis who later developed acute myeloid leukemia.
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