

Early Myocardial Calcification on the Background of Fulminant Lymphocytic-Macrophage Myocarditis
https://doi.org/10.18087/cardio.2025.8.n2920
Abstract
Fulminant myocarditis is characterized by an extremely severe course and remains a life-threatening disease. Only isolated cases of diffuse myocardial calcification in myocarditis have been reported. For this reason, the process of natural evolution of myocardial structural changes and their impact on the cardiovascular system have not yet been sufficiently studied. A clinical case of a 37-year-old patient with morphologically proven fulminant lymphocytic myocarditis and extensive myocardial calcification was selected for the analysis. This article analyzes the course of the disease, an algorithm for diagnosis and selection of a treatment method, and provides a review of previously published studies.
About the Authors
S. V. MayrinaRussian Federation
Junior Researcher at the National Research Institute of Connective Tissue Dysplasia
I. A. Makarov
Russian Federation
pathologist of the pathological anatomy department of the University Clinic and assistant of the department of pathological anatomy with the clinic, Ph.D.in Medicine
K. B. Lapshin
Russian Federation
Head, Intensive Care Unit Department
D. V. Alekseeva
Russian Federation
Assistant Professor of the Department of Radiology and Medical Imaging with Clinic, Ph.D.in Medicine
A. P. Semyonov
Russian Federation
Head of the Department
O. M. Moiseeva
Russian Federation
Director of the Heart and Vascular Institute, Head and Chief Researcher of the Department of Non-Coronarogenic Heart Diseases, Doctor of Medical Sciences, Professor, Honored Scientist of St. Petersburg
References
1. Ammirati E, Cipriani M, Lilliu M, Sormani P, Varrenti M, Raineri C et al. Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis. Circulation. 2017;136(6):529–45. DOI: 10.1161/circulationaha.117.026386
2. Kociol RD, Cooper LT, Fang JC, Moslehi JJ, Pang PS, Sabe MA et al. Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart Association. Circulation. 2020;141(6):e69–92. DOI: 10.1161/cir.0000000000000745
3. Mensah GA, Roth GA, Fuster V. The Global Burden of Cardiovascular Diseases and Risk Factors: 2020 and Beyond. Journal of the American College of Cardiology. 2019;74(20):2529–32. DOI: 10.1016/j.jacc.2019.10.009
4. Lenz M, Krychtiuk KA, Zilberszac R, Heinz G, Riebandt J, Speidl WS. Mechanical Circulatory Support Systems in Fulminant Myocarditis: Recent Advances and Outlook. Journal of Clinical Medicine. 2024;13(5):1197. DOI: 10.3390/jcm13051197
5. Drazner MH, Bozkurt B, Cooper LT, Aggarwal NR, Basso C, Bhave NM et al. 2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis: A Report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. 2025;85(4):391–431. DOI: 10.1016/j.jacc.2024.10.080
6. Kido T, Tanimoto K, Watanabe T, Taira M, Narita J, Ishida H et al. Myocardial calcification: case reports and a systematic review. European Heart Journal -Imaging Methods and Practice. 2024;2(3):qyae079. DOI: 10.1093/ehjimp/qyae079
7. You B, Zeng C, Wang B. Ultra-early myocardial calcification secondary to fulminant myocarditis with 4 years of follow-up: a case report. European Heart Journal -Case Reports. 2023;7(8):ytad302. DOI: 10.1093/ehjcr/ytad302
8. Koo CW, Chan JCK, Bois MC. Fulminant Giant Cell Myocarditis-induced Myocardial Calcification. Radiology: Cardiothoracic Imaging. 2023;5(1):e220305. DOI: 10.1148/ryct.220305
9. Washino M, Tanaka T, Nakase Y, Aoi T, Endo N, Ishikawa H et al. A rare case of myocardial calcification secondary to acute myocarditis due to an Escherichia coli infection. Nagoya Journal of Medical Science. 2020;82(4):775–81. DOI: 10.18999/nagjms.82.4.775
10. Rud R.S., Blagova O.V., Kogan E.A., Novosadov V.M., Zaitsev A.Yu., Sedov V.P. et al. Comparative efficacy and safety of mycophenolate mofetil and azathioprine in combination with corticosteroids in the treatment of lymphocytic myocarditis. Russian Journal of Cardiology. 2021;26(11):31–42.
11. Mairina S.V., Ryzhkova D.V., Mitrofanova L.B., Ryzhkov A.V., Murtazalieva P.M., Moiseeva O.M. Modern approaches to the diagnosis and treatment of cardiac sarcoidosis: results of a cohort study. Russian Journal of Cardiology. 2023;28(5):23–30.
12. Ammirati E, Veronese G, Brambatti M, Merlo M, Cipriani M, Potena L et al. Fulminant Versus Acute Nonfulminant Myocarditis in Patients With Left Ventricular Systolic Dysfunction. Journal of the American College of Cardiology. 2019;74(3):299–311. DOI: 10.1016/j. jacc.2019.04.063
13. Titov V.A., Shishkova A.A., Mitrofanova L.B., Ivanova S.V., Zverev D.A., Marichev A.O. et al. The Case of Fulminant Myocarditis. Kardiologiia. 2019;59(9):91–6.
14. Huang F, Ammirati E, Ponnaiah M, Montero S, Raimbault V, Abrams D et al. Fulminant myocarditis proven by early biopsy and outcomes. European Heart Journal. 2023;44(48):5110–24. DOI: 10.1093/eurheartj/ehad707
15. Nance JW, Crane GM, Halushka MK, Fishman EK, Zimmerman SL. Myocardial calcifications: Pathophysiology, etiologies, differential diagnoses, and imaging findings. Journal of Cardiovascular Computed Tomography. 2015;9(1):58–67. DOI: 10.1016/j.jcct.2014.10.004
16. Ananthakrishna R, Moorthy N. Dystrophic myocardial calcification. Indian Heart Journal. 2016;68(Suppl 2):S180–1. DOI: 10.1016/j. ihj.2016.02.016
17. Rafiee MJ, Bandegi P, Taylor JL. Extensive myocardial calcifications in a dialysis patient: A porcelain heart manifesting with abdominal pain. Radiology Case Reports. 2024;19(2):523–30. DOI: 10.1016/j.radcr.2023.10.081
18. Belkin MN, Dela Cruz M, Nadeem U, Patel AR, Kim G, Grinstein J. Massive Myocardial Calcium Deposition: Hardened Heart. JACC: Case Reports. 2020;2(7):996–1003. DOI: 10.1016/j.jaccas. 2020.03.034
19. De Nicolo B, Cataldi-Stagetti E, Diquigiovanni C, Bonora E. Calcium and Reactive Oxygen Species Signaling Interplays in Cardiac Physiology and Pathologies. Antioxidants. 2023;12(2):353. DOI: 10.3390/antiox12020353
20. Tung RT, Heyns J. Incidental Detection of Massive Left Ventricular Calcification by Myocardial Perfusion Imaging: A Case of Image Illustrations. Kansas Journal of Medicine. 2021;14:256–8. DOI: 10.17161/kjm.vol14.15359
21. Alyesh DM, Siontis KC, Sharaf Dabbagh G, Yokokawa M, Njeim M, Patel S et al. Postinfarction Myocardial Calcifications on Cardiac Computed Tomography: Implications for Mapping and Ablation in Patients With Nontolerated Ventricular Tachycardias. Circulation: Arrhythmia and Electrophysiology. 2019;12(5):e007023. DOI: 10.1161/circep.118.007023
Review
For citations:
Mayrina S.V., Makarov I.A., Lapshin K.B., Alekseeva D.V., Semyonov A.P., Moiseeva O.M. Early Myocardial Calcification on the Background of Fulminant Lymphocytic-Macrophage Myocarditis. Kardiologiia. 2025;65(8):89-95. (In Russ.) https://doi.org/10.18087/cardio.2025.8.n2920