Glucocorticoid-sensitive Paroxysmal Atrial Fibrillation, Sick Sinus Syndrome, and Mitral Regurgitation in a Patient with Malignant Rheumatoid Vasculitis

Ayu Shono; Shumpei Mori; Keita Nakamura; Atsusuke Yatomi; Hiroki Takada; Hidekazu Tanaka; Takaichi Okano; Akio Morinobu; Ken-ichi Hirata

doi:10.2169/internalmedicine.3090-19

CASE REPORTS

Glucocorticoid-sensitive Paroxysmal Atrial Fibrillation, Sick Sinus Syndrome, and Mitral Regurgitation in a Patient with Malignant Rheumatoid Vasculitis

Ayu Shono, Shumpei Mori, Keita Nakamura, Atsusuke Yatomi, Hiroki Takada, Hidekazu Tanaka, Takaichi Okano, Akio Morinobu, Ken-ichi Hirata

Author information

Ayu Shono
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
Shumpei Mori
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
Keita Nakamura
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
Atsusuke Yatomi
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
Hiroki Takada
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
Hidekazu Tanaka
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
Takaichi Okano
Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Japan
Akio Morinobu
Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Japan
Ken-ichi Hirata
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan

Keywords: mitral regurgitation, paroxysmal atrial fibrillation, prednisolone, rheumatoid vasculitis, sick sinus syndrome

JOURNAL OPEN ACCESS

2019 Volume 58 Issue 21 Pages 3093-3098

DOI https://doi.org/10.2169/internalmedicine.3090-19

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Abstract

An 80-year-old woman with rheumatoid arthritis presented with chest pain. Clinical examination revealed new-onset paroxysmal atrial fibrillation with symptomatic sinus pauses and worsening mitral regurgitation, which were both resistant to conventional therapies. Based on her skin lesions, an increase in pleural and pericardial effusion, possible myocardial involvement, and a positive finding for immune complex testing, rheumatoid vasculitis was diagnosed. Subsequent glucocorticoid therapy suppressed systemic inflammation, resulting in structural, functional, and electrical reverse remodeling of the left atrium with complete remission of atrial arrhythmias and also an improvement of mitral regurgitation. This case highlights the importance of evaluating the underlying disease activity in a case of de novo paroxysmal atrial fibrillation associated with systemic autoimmune disease.

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