131 A MORE UNIQUE THAN RARE MYOPERICARDITIS - A CASE REPORT

Abstract A 33yo man, ex-convict, with a history of IV substance abuse, without previous cardiological history, was admitted at our emergency department in the clinical context an acute pericarditis, intermittent fever last 10 days and non-itchy maculo-papular erythema palms thorax. EKG documented diffuse ST-segment elevation, chest X-rays revealed bilateral pleural effusion echocardiography normal biventricular morphology function, valvular circumferential pericardial (14mm). The patient Cardiology Unit after negative PCR SARS-CoV-2 test. Blood chemistry showed elevated WBC count important neutrophilia (24.000/mm3; 90% neutrophils), TnI-HS (236 ng/L; n.v. <18 ng/L), C-reactive protein (340 mg/L; < 5mg/L). classic anti-inflammatory therapy set up indomethacin + colchicine little benefit. cultures, bacterial serology (i.e., Tubercolosis, T.gondii, Syphilis, Leptospirosis) viral HIV, HCV, HBV, EBV, HSV) resulted negative. However, empirical antibiotic coverage up: sequentially Piperacillin/Tazobactam, Vancomycin, Linezolid Ceftriaxone. None antibiotics improved patient's status. On contrary, developed allergic reaction to Vancomycin Linezolid. All autoantibodies tested After hospitalization, status continued deteriorate. (max 41°C) not responsive any treatment. evanescent skin rash had spread whole body concomitant peaks. indexes inflammation were rising (C-reactive 400 mg/L) so (36.000/mm3). lost weight (-8kg), hand feet arthralgia, myalgia, painful retronucal lymph nodes, pharyngodynia abdominal pain. An echography CT performed evidence mild splenomegaly. Hepatic cytolysis indices began rise (AST 100 U/L; ALT 150 LDH 385 U/L). At that point, on basis Yamaguchi's Criteria, we suspected could be affected by Adult-onset Still's disease (AOSD) initial stage hemophagocytic lymphohistiocytosis (HLH). Prednisone (IV 2 mg/kg/die) administered for 72h incomplete biochemical response Protein 180 mg/L). Subsequently, Anakinra (SC mg/die) complete less than 72h. AOSD is very uncommon. annual incidence 0.16/100.000 equal distribution between sexes. HLH have been observed 15% patients, meanwhile myopericarditis rare complication. Although rare, it fair know consider complicated tricky diagnostic process myopericarditis. noteworthy point this case report extreme efficacy contexts systemic still clarified concerns duration treatment down-titration these contexts.