Extensive myocardial calcification in septic shock and precursor B-cell acute lymphoblastic leukaemia

Extensive myocardial calcification in septic shock and precursor B-cell acute lymphoblastic... Prediction of cardiac complications for thalassemia major 309 34. Angelucci E, Brittenham GM, McLaren CE, Ripalti M, Baronciani D, Giardini C 39. Borgna-Pignatti C, Meloni A, Guerrini G, Gulino L, Filosa A, Ruffo GB et al.Myocardial et al. Hepatic iron concentration and total body iron stores in thalassemia major. . iron overload in thalassaemia major. How early to check? Br J Haematol 2014;164:579–85. N Engl J Med 2000;343:327–31. 40. Assomull RG, Prasad SK, Lyne J, Smith G, Burman ED, Khan M et al. 35. Olivieri NF, Nathan DG, MacMillan JH, Wayne AS, Liu PP, McGee A et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomy- Survival in medically treated patients with homozygous beta-thalassemia. N Engl J . opathy. J Am Coll Cardiol 2006;48:1977–85. Med 1994;331:574–8. 41. Buja LM, Roberts WC. Iron in the heart. Etiology and clinical significance. Am J 36. Pepe A, Meloni A, Capra M, Cianciulli P, Prossomariti L, Malaventura C et al. Med 1971;51:209–21. Deferasirox, deferiprone and desferrioxamine treatment in thalassemia major pa- 42. Olson LJ, Edwards WD, McCall JT, Ilstrup DM, Gersh BJ. Cardiac iron deposition tients: cardiac iron and function comparison determined by quantitative magnetic . in idiopathic hemochromatosis: histologic and analytic assessment of 14 hearts resonance imaging. Haematologica 2011;96:41–7. from autopsy. J Am Coll Cardiol 1987;10:1239–43. 37. Pepe A, Meloni A, Rossi G, Cuccia L, D’Ascola GD, Santodirocco M et al. 43. Meloni A, Pepe A, Positano V, Favilli B, Maggio A, Capra M et al. Influence of Cardiac and hepatic iron and ejection fraction in thalassemia major: multicentre . myocardial fibrosis and blood oxygenation on heart T2* values in thalassemia pa- prospective comparison of combined deferiprone and deferoxamine therapy tients. J Magn Reson Imaging 2009;29:832–7. against deferiprone or deferoxamine monotherapy. J Cardiovasc Magn Reson 44. Maisch B, Alter P, Pankuweit S. Diabetic cardiomyopathy–fact or fiction? Herz 2013;15:1. 2011;36:102–15. 38. Meloni A, Positano V, Ruffo GB, Spasiano A, D’Ascola DG, Peluso A et al. . 45. Meloni A, Restaino G, Missere M, De Marchi D, Positano V, Valeri G et al.Pancreatic Improvement of heart iron with preserved patterns of iron store by CMR- iron overload by T2* MRI in a large cohort of well treated thalassemia major patients: guided chelation therapy. Eur Heart J Cardiovasc Imaging 2015;16:325–34. can it tell us heart iron distribution and function? Am J Hematol 2015;90:E189–90. IMAGE FOCUS doi:10.1093/ehjci/jex324 Online publish-ahead-of-print 11 December 2017 .................................................................................................................................................... Extensive myocardial calcification in septic shock and precursor B-cell acute lymphoblastic leukaemia 1 2 2 1 2 Rena Ng , David Ferreira *, Allan Davies , Elizabeth Hesketh , and Bruce Bastian 1 2 Paediatric Department, John Hunter Children’s Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia; and Cardiovascular Department, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia * Corresponding author. Tel: (61)433870118; Fax: (61)249214210. E-mail: dave_7@live.com.au A 15-year-old male with Klinefelter syndrome presented with neutropenic septic shock and multiorgan failure. Bone marrow biopsy dem- onstrated precursor B-cell acute lymphoblastic leukaemia. AEIOP chemotherapy was initiated on Day 6 of admission (prednisone, vincristine, daunorubicin, pegylated asparaginase, metho- trexate, and intrathecal cytarabine). At Day 21, during his induction phase, echocardiography demonstrated new widespread myocardial cal- cification. On apical four chamber views, there was dense calcification of the left and right ven- tricular myocardium, the mitral annulus, the interventricular septum, and the interatrial sep- tum (Panel A). Involvement of the papillary muscle was seen on the parasternal short axis view (Panel B). The echocardiographic ejection fraction was visually estimated at 50% (see Supplementary data online, Video S1). Computed tomography revealed dense myo- cardial calcification concentrated around the left ventricle (Panel C). The post contrast car- diac magnetic resonance images demonstrated multifocal areas of delayed enhancement extending from the pericardium to the subendo- cardium with a small pericardial effusion (Panel D). The left ventricular ejection fraction was measured as 36% with minimal tricuspid and mitral regurgitation (see Supplementary data online, Video S2). Extensive myocardial calcification is a rare radiological finding often associated with infection, inflammation, or cytotoxic medications. In this report, we present the rapid development of dystrophic myocardial calcification in the setting of septic shock and precursor B-cell acute lymphoblastic leukaemia. Supplementary data are available at European Heart Journal—Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author 2017. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/3/309/4725020 by Ed 'DeepDyve' Gillespie user on 22 March 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal – Cardiovascular Imaging Oxford University Press

Extensive myocardial calcification in septic shock and precursor B-cell acute lymphoblastic leukaemia

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Abstract

Prediction of cardiac complications for thalassemia major 309 34. Angelucci E, Brittenham GM, McLaren CE, Ripalti M, Baronciani D, Giardini C 39. Borgna-Pignatti C, Meloni A, Guerrini G, Gulino L, Filosa A, Ruffo GB et al.Myocardial et al. Hepatic iron concentration and total body iron stores in thalassemia major. . iron overload in thalassaemia major. How early to check? Br J Haematol 2014;164:579–85. N Engl J Med 2000;343:327–31. 40. Assomull RG, Prasad SK, Lyne J, Smith G, Burman ED, Khan M et al. 35. Olivieri NF, Nathan DG, MacMillan JH, Wayne AS, Liu PP, McGee A et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomy- Survival in medically treated patients with homozygous beta-thalassemia. N Engl J . opathy. J Am Coll Cardiol 2006;48:1977–85. Med 1994;331:574–8. 41. Buja LM, Roberts WC. Iron in the heart. Etiology and clinical significance. Am J 36. Pepe A, Meloni A, Capra M, Cianciulli P, Prossomariti L, Malaventura C et al. Med 1971;51:209–21. Deferasirox, deferiprone and desferrioxamine treatment in thalassemia major pa- 42. Olson LJ, Edwards WD, McCall JT, Ilstrup DM, Gersh BJ. Cardiac iron deposition tients: cardiac iron and function comparison determined by quantitative magnetic . in idiopathic hemochromatosis: histologic and analytic assessment of 14 hearts resonance imaging. Haematologica 2011;96:41–7. from autopsy. J Am Coll Cardiol 1987;10:1239–43. 37. Pepe A, Meloni A, Rossi G, Cuccia L, D’Ascola GD, Santodirocco M et al. 43. Meloni A, Pepe A, Positano V, Favilli B, Maggio A, Capra M et al. Influence of Cardiac and hepatic iron and ejection fraction in thalassemia major: multicentre . myocardial fibrosis and blood oxygenation on heart T2* values in thalassemia pa- prospective comparison of combined deferiprone and deferoxamine therapy tients. J Magn Reson Imaging 2009;29:832–7. against deferiprone or deferoxamine monotherapy. J Cardiovasc Magn Reson 44. Maisch B, Alter P, Pankuweit S. Diabetic cardiomyopathy–fact or fiction? Herz 2013;15:1. 2011;36:102–15. 38. Meloni A, Positano V, Ruffo GB, Spasiano A, D’Ascola DG, Peluso A et al. . 45. Meloni A, Restaino G, Missere M, De Marchi D, Positano V, Valeri G et al.Pancreatic Improvement of heart iron with preserved patterns of iron store by CMR- iron overload by T2* MRI in a large cohort of well treated thalassemia major patients: guided chelation therapy. Eur Heart J Cardiovasc Imaging 2015;16:325–34. can it tell us heart iron distribution and function? Am J Hematol 2015;90:E189–90. IMAGE FOCUS doi:10.1093/ehjci/jex324 Online publish-ahead-of-print 11 December 2017 .................................................................................................................................................... Extensive myocardial calcification in septic shock and precursor B-cell acute lymphoblastic leukaemia 1 2 2 1 2 Rena Ng , David Ferreira *, Allan Davies , Elizabeth Hesketh , and Bruce Bastian 1 2 Paediatric Department, John Hunter Children’s Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia; and Cardiovascular Department, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia * Corresponding author. Tel: (61)433870118; Fax: (61)249214210. E-mail: dave_7@live.com.au A 15-year-old male with Klinefelter syndrome presented with neutropenic septic shock and multiorgan failure. Bone marrow biopsy dem- onstrated precursor B-cell acute lymphoblastic leukaemia. AEIOP chemotherapy was initiated on Day 6 of admission (prednisone, vincristine, daunorubicin, pegylated asparaginase, metho- trexate, and intrathecal cytarabine). At Day 21, during his induction phase, echocardiography demonstrated new widespread myocardial cal- cification. On apical four chamber views, there was dense calcification of the left and right ven- tricular myocardium, the mitral annulus, the interventricular septum, and the interatrial sep- tum (Panel A). Involvement of the papillary muscle was seen on the parasternal short axis view (Panel B). The echocardiographic ejection fraction was visually estimated at 50% (see Supplementary data online, Video S1). Computed tomography revealed dense myo- cardial calcification concentrated around the left ventricle (Panel C). The post contrast car- diac magnetic resonance images demonstrated multifocal areas of delayed enhancement extending from the pericardium to the subendo- cardium with a small pericardial effusion (Panel D). The left ventricular ejection fraction was measured as 36% with minimal tricuspid and mitral regurgitation (see Supplementary data online, Video S2). Extensive myocardial calcification is a rare radiological finding often associated with infection, inflammation, or cytotoxic medications. In this report, we present the rapid development of dystrophic myocardial calcification in the setting of septic shock and precursor B-cell acute lymphoblastic leukaemia. Supplementary data are available at European Heart Journal—Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author 2017. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/3/309/4725020 by Ed 'DeepDyve' Gillespie user on 22 March 2018

Journal

European Heart Journal – Cardiovascular ImagingOxford University Press

Published: Mar 1, 2018

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