Fiessinger-Leroy-Reiter syndrome with non-obstructive cardiomyopathy treated with methotrexate
Blétry, O.; De Prost, Y.; Scheuble, C.; Frank, R.; Godeau, P.
Archives des Maladies du Coeur et des Vaisseaux 72(7): 799-805
1979
ISSN/ISBN: 0003-9683 PMID: 117779 Document Number: 139973
The case of a 50 year old male with the Fiessinger-Leroy-Reiter syndrome, ankylosing spondylitis and generalised pustular psoriasis is reported. This condition wax complicated by non-obstructive cardiomyopathy, congestive cardiac failure and first-degree atrioventricular block, the site of which was localised by electrophysiological studies (nodal block with an infrahisian conduction defect). After failure of several therapeutic regimes, a spectacular improvement was obtained with Methotrexate associated with a diuretic; the signs of heart failure regressed and the cardiomyopathy stablised. A parallel improvement was seen in the skin, cardiac and articular lesions and has been maintained with an 18 months follow-up. Left ventricular performance was studied by echocardiography. The mechanism of the beneficial effect of Methotrexate is unclear; this therapeutic trial is to be extended to include other cases of primary cardiomyopathy without obstruction.