Pediatric myocarditis: A sentinel of non-cardiac chronic diseases?

Introduction: Although long-term outcome studies in large pediatric myocarditis/cardiomyopathy populations have been reported in literature, none of them focused on comorbidities. Methods: All children and adolescents (age <18 years) treated with myocarditis at the Department of Pediatrics, University of Debrecen, Hungary were followed. Patients suff ering from myocarditis during the period 1996-2011 were enrolled. Results: Over the 16-year period, a diagnosis of myocarditis was established in nine children. Their median age was 1.11 (0.03- 8.71) years. Three of the nine patients died. Left ventricular dilatation and ejection fraction normalized within 1-21 months i n the survivors. None of the cases progressed to dilated cardiomyopathy. Regarding non-cardiac comorbidities, myocarditis or recurrent peri-myoc arditis preceded the manifestation of celiac disease in two patients, while cystic fi brosis was diagnosed after the improvement of cardiac function in another, and Alstrom syndrome was diagnosed several years after complete recovery from myocarditis in yet another patient. Conclusion: These results suggest that manifestations of other chronic pediatric diseases may be more frequent among survivors of pediatric myocarditis. Prolonged follow-up of patients who survive myocarditis is therefore recommended not only to detect possible progression to car diomyopathy but also to identify non-cardiac comorbidities.