Suesaowalak Monnipa, Cheung Michele M, Tucker Dawn, Chang Anthony C, Chu James, Arrieta Antonio
Pediatric Cardiac Surgery Foundation, Institute of Cardiovascular Disease, Rajvithi Hospital, Rajthevee, Bangkok, Thailand.
Pediatr Cardiol. 2009 Apr;30(3):336-9. doi: 10.1007/s00246-008-9301-5. Epub 2008 Oct 25.
An 11-year-old boy with serologically confirmed Chlamydophila pneumoniae infection presented with clinical, laboratory, and echocardiographic changes consistent with myopericarditis. No reports on C. pneumoniae myopericarditis in children are found in the medical literature. The boy, previously healthy, presented with fever, rash, constitutional symptoms, elevated acute phase reactants, elevated cardiac enzymes, and high brain natriuretic peptide levels. Hemodynamic instabilities, including hypotension and mild hypoxia, were noted. Two-dimensional echocardiographic findings showed mildly depressed left ventricular systolic function and small pericardial effusion. Requiring inotropic support, the boy was treated with azithromycin 10 mg/kg once daily for 7 days and a single dose of intravenous immunoglobulin 2 g/kg. He recovered fully with improved left ventricular systolic function before hospital discharge. An early definitive diagnosis is essential to knowing the etiology of pediatric myocarditis. Specific therapy may play role in the management and prognosis of this disorder.
一名11岁血清学确诊为肺炎衣原体感染的男孩出现了与心肌心包炎相符的临床、实验室及超声心动图改变。医学文献中未发现关于儿童肺炎衣原体心肌心包炎的报道。该男孩既往健康,出现发热、皮疹、全身症状、急性期反应物升高、心肌酶升高及脑钠肽水平升高。观察到血流动力学不稳定,包括低血压和轻度低氧血症。二维超声心动图结果显示左心室收缩功能轻度降低及少量心包积液。因需要正性肌力支持,该男孩接受阿奇霉素10mg/kg每日1次共7天治疗及单剂量静脉注射免疫球蛋白2g/kg。出院前他完全康复,左心室收缩功能改善。早期明确诊断对于了解小儿心肌炎的病因至关重要。特异性治疗可能在该疾病的管理及预后中发挥作用。