Yonenaga Akihiko, Hasumi Eriko, Fujiu Katsuhito, Ushiku Aya, Hatano Masaru, Ando Jiro, Morita Hiroyuki, Watanabe Masafumi, Komuro Issei
Department of Cardiovascular Medicine, The University of Tokyo Hospital.
Department of Pathology, The University of Tokyo Hospital.
Int Heart J. 2018 May 30;59(3):641-646. doi: 10.1536/ihj.17-308. Epub 2018 May 6.
We present the case of a patient with acute necrotizing eosinophilic myocarditis (ANEM) who rapidly recovered after receiving high-dose corticosteroid therapy. A previously healthy 29-year-old woman presented to our hospital with abdominal pain, nausea, and fever that had lasted for two days. Her clinical condition progressively declined and she ultimately presented with cardiogenic shock due to fulminant heart failure and atrioventricular dissociation due to sinus bradycardia, which required inotropic and ventilatory support. Endomyocardial biopsy results were consistent with ANEM. High-dose corticosteroids were promptly initiated, and her cardiac function rapidly improved, with almost complete cardiac recovery one week later. She survived with completely normalized left ventricular systolic and diastolic function after high-dose corticosteroid therapy. The prompt and definite pathological diagnosis based on endomyocardial biopsy in the acute phase might have been instrumental in improving the outcome.
我们报告了一例急性坏死性嗜酸性粒细胞性心肌炎（ANEM）患者，该患者在接受大剂量皮质类固醇治疗后迅速康复。一名此前健康的29岁女性因持续两天的腹痛、恶心和发热前来我院就诊。她的临床状况逐渐恶化，最终因暴发性心力衰竭出现心源性休克，并因窦性心动过缓导致房室分离，需要进行强心和通气支持。心内膜活检结果与ANEM一致。迅速开始使用大剂量皮质类固醇，她的心脏功能迅速改善，一周后心脏几乎完全恢复。大剂量皮质类固醇治疗后，她存活下来，左心室收缩和舒张功能完全恢复正常。急性期基于心内膜活检的迅速而明确的病理诊断可能有助于改善预后。
