Myocarditis and intramural coronary vasculitis in polyarteritis nodosa: an unusual treatable form of heart failure

We describe an uncommon cardiac presentation of polyarteritis nodosa. A 68-year-old woman, with a history of fatigue, weight loss, and myalgia of the lower extremities, was admitted for congestive heart failure. Coronary arteries were normal. Endomyocardial biopsy showed active lymphocytic myocarditis with associated intramural small vessels necrotizing vasculitis. The overexpression of TLR-4 and the negativity for myocardial viruses suggested an immune mediated mechanism of cardiac damage. These histologic findings associated to weight loss >4 kg not due to dieting or other factors, myalgias, and polyneuropathy, were consistent with the diagnosis of polyarteritis nodosa. Immunosuppressive treatment, consisting of cyclophosphamide and prednisolone, led to a significant improvement of cardiac function. Polyarteritis nodosa can be the cause of unexplained heart failure due to myocarditis and intramural vessels vasculitis. Its recognition is crucial to obtain a cardiac recovery with a tailored immunosuppressive treatment

The diagnosis of PCOS in young infertile women according to different diagnostic criteria: the role of serum anti-Müllerian hormone

To diagnose polycystic ovary syndrome (PCOS) in young infertile women using different diagnostic criteria. To define serum anti-Mullerian hormone (AMH) cutoff values for PCOS definition. To investigate the correlation between AMH and body mass index (BMI).Retrospective case-control study. A total of 140 infertile women (age 21-35 years) were enrolled. PCOS was defined according to the National Institutes of Health (NIH) criteria, the Rotterdam consensus criteria and the Androgen Excess and PCOS Society (AE-PCOS) criteria. ROC curve analysis was performed to define AMH thresholds for PCOS definition according to the three different diagnostic criteria. Correlation between AMH and BMI was investigated.The prevalence of PCOS under the NIH criteria, the Rotterdam criteria and the AE-PCOS criteria was 27.1, 40 and 29.3%, respectively. The optimal thresholds of AMH to distinguish NIH PCOS from infertile controls was 5.20 ng/ml (AUC = 0.86, sensitivity 79%, specificity 80%); the best cutoff to detect Rotterdam PCOS was 4.57 ng/ml (AUC = 0.85, sensitivity 78%, specificity 81%); a cutoff of 4.85 ng/ml (AUC = 0.85, sensitivity 80%, specificity 78%) defined PCOS women according to AE-PCOS criteria. The prevalence of the syndrome became 37.1, 44.3 and 39.2% according to the three criteria, respectively, using AMH threshold between 4.57 and 5.20 ng/ml as an alternative to antral follicle count and/or hyperandrogenism.Anti-Mullerian hormone may reconcile the three diagnostic criteria and allow the PCOS diagnosis in women with mild symptoms. No significant correlation was found between AMH and BMI in PCOS women and controls