Sui Mingliang, Tang Weibing, Wu Changjiang
Department of Critical Care Medicine, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China.
Medicine (Baltimore). 2018 Dec;97(49):e13582. doi: 10.1097/MD.0000000000013582.
The Epstein-Barr (EB) virus has rarely been reported as a cause of fulminant myocarditis. To our knowledge, the present case is the first report on myocardial calcification in EB viral myocarditis and rhabdomyolysis.
A 17-year-old man was admitted to the department with fever, chest tightness, and tachypnea that had been present for 2 days.
The initial investigation showed elevated liver enzyme levels, creatine kinase levels, creatine kinase isoenzyme levels, and elevated serum myoglobin. Echocardiography showed that left ventricular motion amplitude decreased. Test for immunoglobin M and immunoglobin G antibodies against Epstein-Barr virus were positive. These findings were consistent with fulminant myocarditis, cardiogenic shock, and rhabdomyolysis.
The patient was intensively treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO), continuous renal replacement therapy (CRRT).
Myocardial calcification was observed in the left ventricle walls on CT examination 10 days after the admission. Four months later, the patient is still alive and with adequate daily life.
This case indicates that this rare form of myocardial calcification may be associated with EB viral infection and rhabdomyolysis.
爱泼斯坦-巴尔（EB）病毒作为暴发性心肌炎的病因鲜有报道。据我们所知，本病例是关于EB病毒性心肌炎合并横纹肌溶解伴心肌钙化的首例报道。
一名17岁男性因发热、胸闷、气促2天入院。
初步检查显示肝酶水平、肌酸激酶水平、肌酸激酶同工酶水平升高，血清肌红蛋白升高。超声心动图显示左心室运动幅度降低。抗EB病毒免疫球蛋白M和免疫球蛋白G抗体检测呈阳性。这些结果符合暴发性心肌炎、心源性休克和横纹肌溶解。
患者接受了静脉-动脉体外膜肺氧合（VA-ECMO）、连续性肾脏替代治疗（CRRT）强化治疗。
入院10天后CT检查发现左心室壁有心肌钙化。四个月后，患者仍然存活，日常生活正常。
本病例表明这种罕见的心肌钙化形式可能与EB病毒感染和横纹肌溶解有关。
