Inflammatory dilated cardiomyopathy associated with psoriasis: a case report

Abstract

Background: Psoriasis is a chronic inflammatory skin disease with a genetic basis. Psoriasis is accepted as a systemic, immune-mediated disease. Hypertension, obesity, metabolic disorders including diabetes mellitus and hyperlipidemia, and psychiatric disorders are more prevalent among children with psoriasis compared to children without psoriasis. In this study, we report a case of dramatic response of inflammatory cardiomyopathy to anti-inflammatory treatment of psoriasis; which might reveal similar pathogenesis basis of these two diseases.

Case presentation: A 9-year-old Caucasian boy presenting with signs and symptoms of heart failure refractory to conventional therapies was admitted to our pediatric cardiology service. As the patient also had psoriasis, and considering the fact that there might be an association between the two conditions, immunosuppressive drugs were administered, which led to a dramatic improvement in heart function.

Conclusions: The results of this study add to evidence linking psoriasis with inflammatory dilated cardiomyopathy. Clinicians, particularly cardiologists, must pay special attention to the cardiac complications of systemic diseases.

Keywords: Case report; Heart failure; Inflammatory cardiomyopathy; Psoriasis.

Fig. 1

Psoriatic lesions in foot and hands (the arrows). In this patient, psoriatic lesions were found since the age of two, which had a chronic course and no flare-ups were reported. The psoriatic lesions have been partially controlled through the application of emollients and topical corticosteroids

Fig. 2

Chest X-ray PA view showing cardiomegaly and hepatomegaly in the patient

Fig. 3

Holter monitoring showing premature ventricular contractions (PVCs) in D2 lead in the patient (the red circles)

Fig. 4

Echocardiography of the patient. A Left ventricle dilatation and its large size compared with the right ventricle and other cavities are evident. Ejection Fraction (EF) of 39%, and severe mitral regurgitation were also reported. B The left ventricular sphericity index (LVSI) is 0.80 (4.90 cm/3.95 cm). LVSI is measured by the LV short-to-long-axis dimension ratio in end-diastolic apical four-chamber view. LVSI has been validated as a direct measure of LV remodeling in patients with dilated cardiomyopathy [28]

Fig. 5

Cardiac Magnetic Resonance Imaging (MRI) and Steady-State Free Precession (SSFP) showed cardiac chamber dilation. Left ventricular thickness was mildly thinned associated with increased end-diastolic volume in right ventricle. In addition, low signal intensity was seen in T1, however, high signal intensity and decreased EF was seen in T2. Late Gadolinium Enhancement (LGE) showed linear mid-myocardial enhancement in interventricular septum (LV End-Systolic Volume = 103.1 ml; LV End-Diastolic Volume = 137.2 ml; LV Ejection Fraction = 25%; Stroke Volume = 34.1 ml; Cardiac Output = 3.4 l/min; Cardiac Index = 3.9 l/min/m²)