case_images: PMC9135130_01
case_images: Clinical course and changes in CK and troponin in case 1.
case_images: fphar-13-884776-g001.jpg
case_images: PMC9135130_01_fphar-13-884776-g001.jpg
case_images: F1
case_images: T (0.474 ng/ml [normal level, <0.1 ng/ml]) (Figure 1). The patient was admitted to our hospital with suspected myocarditis and myositis. Histopathological analysis of the biopsy samples revealed strong infiltration of CD4+ T cells, CD8+ T cells, and CD68+ histiocytes, with mild infiltration of CD20+ B lymphocytes (Supplementary Figure S1). Immediately after steroid pulse therapy, she recovered from myositis as CK decreased and myalgia disappeared, but myocarditis activity increased as indicated by an increase in troponin level (Figure 1).
case_images: PMC9135130_02
case_images: Clinical course and changes in CK and troponin in case 2.
case_images: fphar-13-884776-g002.jpg
case_images: PMC9135130_04_fphar-13-884776-g002.jpg
case_images: F2
case_images: Lymphocytes were a mixture of CD3+ T cells and CD20+ B cells with infiltration of CD68+ macrophages (Supplementary Figure S2).
case_images: PMC9135130_03
case_images: Clinical course and changes in CK and troponin in case 3.
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case_images: PMC9135130_03_fphar-13-884776-g003.jpg
case_images: F3
case_images: He had elevated levels of serum CK (11,021 U/L [normal range, 63-257 U/L]) and troponin T (2.02 ng/ml) (Figure 3). After steroid pulse therapy, the patient quickly recovered from myositis and MG as CK decreased and his eyelid ptosis improved, but myocarditis activity increased, as indicated by elevated troponin levels and persistent chest discomfort (Figure 3).
case_images: PMC9135130_04
case_images: Clinical course and changes in CK and troponin in case 2.
case_images: fphar-13-884776-g002.jpg
case_images: PMC9135130_04_fphar-13-884776-g002.jpg
case_images: F2
case_images: Lymphocytes were a mixture of CD3+ T cells and CD20+ B cells with infiltration of CD68+ macrophages (Supplementary Figure S2).
case_images: Clinical course and changes in CK and troponin in case 4.
case_images: fphar-13-884776-g004.jpg
case_images: PMC9135130_04_fphar-13-884776-g004.jpg
case_images: F4
case_images: However, as shown in Figure 4, troponin levels significantly increased despite a decrease in CK levels (Figure 4).