Tada Yuko, Uto Kenta, Wada Hiroshi, Sakakura Ken-Ichi, Suzuki Jun-Ichi, Nishikawa Toshio, Ako Junya, Momomura Shin-Ichi
Division of Cardiovascular Medicine, The University of Tokyo, Japan.
Department of Pathology, Tokyo Women's Medical University, Japan.
Cardiol Res. 2013 Apr;4(2):78-81. doi: 10.4021/cr261w. Epub 2013 May 9.
We report a rare case of fulminant myocarditis that was considered to have smoldered for a few months before it finally exteriorized. An 80-year-old man had had two episodes of mild congestive heart failure with preserved ejection function (HFPEF) within 3 months before he was finally admitted for the treatment of rapidly progressive heart failure. Cardiac function deteriorated remarkably on the final admission. Extracorporeal cardiopulmonary support was used because of pump failure and conduction disability, however, the patient died on the 16th day. Endomyocardial biopsy revealed numerous inflammatory infiltrates in myocardium compatible with fulminant myocarditis. However, advanced fibrosis and increased number of B lymphocytes and plasma cells found in the present case were not typical for fulminant myocarditis. Considering several distinctive findings in clinical and laboratory findings together, two preceding HFPEF episodes were highly likely to be associated with myocarditis.
我们报告了一例罕见的暴发性心肌炎病例，该病例在最终发作前被认为已隐匿了数月。一名80岁男性在最终因快速进展性心力衰竭入院治疗前3个月内曾发生过两次射血功能保留的轻度充血性心力衰竭（HFpEF）。最终入院时心脏功能显著恶化。由于泵衰竭和传导障碍，采用了体外心肺支持，但患者在第16天死亡。心内膜活检显示心肌中有大量炎性浸润，符合暴发性心肌炎。然而，本病例中发现的晚期纤维化以及B淋巴细胞和浆细胞数量增加并非暴发性心肌炎的典型表现。综合临床和实验室检查中的多项独特发现，之前的两次HFpEF发作很可能与心肌炎有关。
