Miura M, Asaumi Y, Wada Y, Ogata K, Sato T, Sugawara T, Yano M, Mitsu-Oka M, Takai O, Ota K, Namiki K, Sato D, Sato E, Nagura H, Kimura T
Department of Internal Medicine, Furukawa City Hospital, Furukawa, Japan.
Tohoku J Exp Med. 2001 Sep;195(1):11-9. doi: 10.1620/tjem.195.11.
A 64-year-old man was admitted to the emergency center of Furukawa City Hospital because of common cold-like symptoms and hypotension. He was diagnosed as fulminant myocarditis with cardiogenic shock and arrhythmia elicited by influenza virus subtype A. Cardiac angiography, echocardiography and biopsy also showed myocarditis, and serum antibody titer to influenza virus subtype A was increased to 4-fold in paired serums. Treatments of both percutaneous cardio-pulmonary support (PCPS) and intra-aortic balloon pumping (IABP) were carried out to sustain the general circulation. PCPS treatment was discontinued on the 25th day of the admission, but IABP was continued. Finally, he died of multiple organ failure. The autopsy revealed myocardial necrosis with a slight fibrosis and a small amount of lymphocytic infiltration into the ventricular wall, which were compatible with restrictive myocarditis. Moreover, immunohistochemical analysis also showed the presence of viral antigens in cardiac myocytes. This case clearly showed that PCPS and IABP can be beneficial to sustain the general circulation in fulminant myocarditis, but cardiac pumping function failed completely to recover from myocardial damage.
一名64岁男性因类似普通感冒的症状和低血压入住古河市立医院急诊中心。他被诊断为暴发性心肌炎，伴有由甲型流感病毒引起的心源性休克和心律失常。心脏血管造影、超声心动图和活检也显示为心肌炎，且配对血清中甲型流感病毒的血清抗体滴度升高至4倍。进行了经皮心肺支持（PCPS）和主动脉内球囊反搏（IABP）治疗以维持全身循环。入院第25天停止了PCPS治疗，但IABP仍继续进行。最终，他死于多器官功能衰竭。尸检显示心肌坏死伴轻度纤维化，少量淋巴细胞浸润心室壁，符合限制性心肌炎。此外，免疫组织化学分析还显示心肌细胞中存在病毒抗原。该病例清楚地表明，PCPS和IABP有助于维持暴发性心肌炎患者的全身循环，但心脏泵血功能未能从心肌损伤中完全恢复。
