Tanimura Muneyoshi, Dohi Kaoru, Imanaka-Yoshida Kyoko, Omori Taku, Moriwaki Keishi, Nakamori Shiro, Yamada Norikazu, Ito Masaaki
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine.
Int Heart J. 2017 Apr 6;58(2):294-297. doi: 10.1536/ihj.16-225. Epub 2017 Mar 21.
Fulminant myocarditis is a highly mortal syndrome. Meanwhile, the clinical course in surviving patients is generally self-limiting. This is a rare case of fulminant myocarditis with prolonged lymphocytic infiltration after hemodynamic recovery. A 64-year-old man was diagnosed with fulminant myocarditis and required intensive care with veno-arterial extracorporeal membrane oxygenation. Left ventricular function gradually improved but complete atrioventricular block (CAVB) persisted. Follow-up endomyocardial biopsies (EMBs) showed prolonged active infiltration of lymphocytes along with F-FDG uptake in F-FDG PET/CT until about 70 days after the onset. Therefore, he underwent immunosuppressive therapy for 3 months. Follow-up EMB revealed no evidence of infiltration of lymphocytes and no abnormal F-FDG uptake despite irreversible CAVB. Although repeated EMB and F-FDG PET/CT was not a standard strategy, it played an important role in the treatment decision in the present case.
暴发性心肌炎是一种死亡率很高的综合征。同时，存活患者的临床病程通常为自限性。这是一例罕见的暴发性心肌炎病例，在血流动力学恢复后淋巴细胞浸润持续时间延长。一名64岁男性被诊断为暴发性心肌炎，需要接受静脉-动脉体外膜肺氧合的重症监护。左心室功能逐渐改善，但完全性房室传导阻滞（CAVB）持续存在。随访的心内膜心肌活检（EMB）显示，淋巴细胞持续活跃浸润，同时在发病后约70天内，18F-氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（F-FDG PET/CT）显示有18F-氟代脱氧葡萄糖摄取。因此，他接受了3个月的免疫抑制治疗。随访的EMB显示，尽管存在不可逆的CAVB，但没有淋巴细胞浸润的证据，也没有异常的18F-氟代脱氧葡萄糖摄取。虽然重复进行EMB和F-FDG PET/CT并非标准策略，但在本例的治疗决策中发挥了重要作用。
