Khan Hafiz Muhammad Waqas, Yousaf Amman, Ahmad Muhammad, Changezi Hameem U
Department of Cardiovascular Disease, Michigan State University/McLaren, Flint, MI 48532, USA.
Department of Internal Medicine, Michigan State University/McLaren, Flint, MI 48532, USA.
Eur Heart J Case Rep. 2023 Jan 2;7(1):ytac488. doi: 10.1093/ehjcr/ytac488. eCollection 2023 Jan.
is a well-known cause of gas gangrene with a very high mortality rate. Multiple cases of internal organs have been reported in the literature; however, non-traumatic spontaneous gas gangrene due to with solely cardiac involvement in a patient without any risk factors has not been reported before.
A 52-year-old male presented to the emergency department with chest pain and exertional dyspnoea for three days. The patient was haemodynamically stable initially, and the physical examination was unremarkable. Initial laboratory workup revealed elevated D-dimer and troponin levels. Computerized tomography (CT) of the chest was negative for pulmonary embolism but showed a hypodense focus in the cardiac silhouette. Acute coronary syndrome protocol was initiated; however, invasive cardiac workup was negative. The patient had rapid clinical deterioration with development of respiratory failure, shock, and multiorgan failure within 24 h. A transesophageal echocardiogram demonstrated an abnormal echogenic focus, corresponding to CT chest area. Despite aggressive treatment, the patient passed away within 36 h. Later, the patient's blood culture grew . A limited autopsy showed an abscess cavity in the interventricular septum, pathology of which revealed acute myocarditis and fibrinous pericarditis.
Unlike other reported cases of with cardiac abscess, our patient had no known risk factors, and no other organs were involved. We conclude from this case that an air focus on the CT scan in the myocardium can be suggestive of a spontaneous gas gangrene of the myocardium, and the patients should be treated accordingly.
是气性坏疽的一个众所周知的病因，死亡率极高。文献中已报道多例累及内部器官的病例；然而，之前尚未报道过在没有任何危险因素的患者中因单独累及心脏而发生的非创伤性自发性气性坏疽。
一名52岁男性因胸痛和劳力性呼吸困难3天就诊于急诊科。患者最初血流动力学稳定，体格检查无异常。初始实验室检查显示D-二聚体和肌钙蛋白水平升高。胸部计算机断层扫描（CT）排除了肺栓塞，但显示心脏轮廓内有一个低密度灶。启动了急性冠状动脉综合征诊疗方案；然而，侵入性心脏检查结果为阴性。患者在24小时内临床迅速恶化，出现呼吸衰竭、休克和多器官功能衰竭。经食管超声心动图显示一个异常的回声灶，与胸部CT区域相对应。尽管进行了积极治疗，患者在36小时内死亡。后来，患者的血培养培养出 。有限的尸检显示室间隔有一个脓肿腔，病理显示为急性心肌炎和纤维蛋白性心包炎。
与其他报道的伴有心脏脓肿的病例不同，我们的患者没有已知的危险因素，且没有其他器官受累。我们从这个病例得出结论，心肌CT扫描上的气体灶可能提示心肌自发性气性坏疽，应相应地对患者进行治疗。
