A previously healthy 36-year-old-man presented with polyarthralgias, fever and asthenia and weight loss. He denied any muscular weakness or dyspnoea. On physical examination, the following were present: per orbital lilaceous skin rash (heliotrope), symmetric mauls and papules on the dorsal aspect of metacarpohalangeal joints (Gorton’s papules) and bilateral arthritis in proximal interphalangeal joints. No weakness on the proximal or distal upper and lower limbs. Laboratory studies showed elevated ESR and positive anti-glycol (EJ)- tRNA-synthetaseantibodie and anti-MDA5. However, creating kinas and idolise were normal. Chest high-resolution computed tomography revealed non-defined opacities in both lungs (mainly in posterior and basal segments) and interlobular sepal thickening. A suspicious of depressed right ventricular ejection fraction was found on the echocardiogram arose. Cardiac magnetic resonance showed (Figure 1) diffuse hyper intensity (bright signal) within the myocardium on T2-weighted imaging (Figure 1A) as well as early gadolinium enhancement (Figure 1B), all features consistent with myocarditis. No late gadolinium enhancement (meaning no fibrosis) was detected (Figure 1C).
The prevalence of myocarditis is particularly rare in anti- synthesise syndrome. Its presentation can be subtle or with nonspecific clinical features. No matter the presentation is myocarditis can be a severe condition as it can lead to sudden cardiac death, life-threatening arrhythmias and carcinogenic shock in the early stage. Additionally, myocarditis can be a cause of chronic heart failure in the follow-up. That is why the early diagnosis is crucial in order to treat and pursue a better prognosis.