Cor Vasa 2018, 60(6):e645-e648 | DOI: 10.1016/j.crvasa.2018.10.001

High-sensitive cardiac troponin T is not always heart - Paraneoplastic systemic sclerosis simulated myocardial ischemia

Johannes Mierke^a,*, Stefanie Jellinghaus^a, Anna Selle^a, Hagen Schroetter^a, David M. Poitz^b, Karim Ibrahim^a

^a Technische Universität Dresden, Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Germany

^b Technische Universität Dresden, Faculty of Medicine, Institute for Clinical Chemistry and Laboratory Medicine, Dresden, Germany

Background: The high-sensitive cardiac troponin T (hs-cTnT, Elecsys®) is an excellent and worldwide used diagnostic marker for myocardial ischemia with high sensitivity. However, elevated hs-cTnT levels are found in different systemic diseases and can lead to misdiagnosis. The high-sensitive cardiac troponin I (hs-cTnI, ARCHITECT®) shows comparable sensitivity. However, hs-cTnI is much more specific than hs-cTnT (92% vs. 80%, 99th percentile).
Case summary: An asymptomatic women with a cancer of unknown primary (CUP) presented constantly high hs-cTnT. Electrocardiogram, echocardiography as well as cardiac MRI and CT angiography of the coronary arteries showed no pathological findings. A repeated clinical examination revealed a localized scleroderma and autoimmune antibody pattern diagnosed a paraneoplastic systemic sclerosis (SSc). Therefore, a treatment with Rituximab - a CD20 antibody - was initiated, which reduced activity of SSc and also concentration of hs-cTnT.

Conclusion: In the present case, a localized scleroderma due to a paraneoplastic systemic sclerosis (SSc) was accompanied by elevated hs-cTnT levels in the absence of cardiovascular disease. A reduced inflammation of skeletal muscle tissue due to rituximab treatment decreased hs-cTnT levels. This is the first report of an occult hs-cTnT elevation due to paraneoplastic SSc.

Keywords: Biomarkers; High sensitive troponins; Paraneoplastic syndrome; Systemic sclerosis

Received: June 20, 2018; Accepted: October 15, 2018; Published: December 1, 2018  Show citation