McGee Michael, Shiel Emily, Brienesse Stephen, Murch Stuart, Pickles Robert, Leitch James
Cardiovascular Department, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia.
Infectious Diseases Department, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia.
Case Rep Cardiol. 2018 May 23;2018:7017286. doi: 10.1155/2018/7017286. eCollection 2018.
myocarditis is a rare diagnosis with a high mortality rate, usually seen in people who are immunocompromised. Here, we report a case of a 44-year-old man on methotrexate for rheumatoid arthritis who presented in septic shock and was diagnosed with myocarditis. The myocarditis was associated with a left ventricular apical thrombus, with normal systolic function. The myocarditis and associated thrombus were characterised on transthoracic echocardiogram and subsequently on cardiac magnetic resonance imaging. Cardiac magnetic resonance (CMR) imaging showed oedema in the endomyocardium, consistent with acute myocarditis, associated with an apical mural thrombus. Repeat CMR 3 weeks following discharge from hospital showed marked improvement in endomyocardial oedema and complete resolution of the apical mural thrombus. He was treated with a 12-week course of antibiotics and anticoagulated with apixaban. The patient was successfully managed with intravenous antibiotics and anticoagulation with complete recovery.
心肌炎是一种罕见的诊断，死亡率很高，通常见于免疫功能低下的人群。在此，我们报告一例44岁男性患者，因类风湿关节炎正在接受甲氨蝶呤治疗，出现感染性休克，被诊断为心肌炎。该心肌炎伴有左心室心尖部血栓，收缩功能正常。通过经胸超声心动图以及随后的心脏磁共振成像对心肌炎及相关血栓进行了特征性描述。心脏磁共振（CMR）成像显示心内膜水肿，符合急性心肌炎表现，并伴有心尖部壁血栓。出院3周后复查CMR显示心内膜水肿明显改善，心尖部壁血栓完全消失。他接受了为期12周的抗生素治疗，并使用阿哌沙班进行抗凝。该患者通过静脉使用抗生素和抗凝治疗成功得到管理，完全康复。
