Ushiyama Yumiko, Horimoto Yoshiya, Uomori Toshitaka, Ishizuka Yumiko, Okazaki Misato, Onagi Hiroko, Hayashi Takuo, Watanabe Junichiro, Saito Mitsue
Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
Department of Human Pathology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
Surg Case Rep. 2023 Mar 23;9(1):44. doi: 10.1186/s40792-023-01626-7.
With the improvement of optimal perioperative drug therapy for breast cancer patients, physicians now have to treat the adverse effects and comorbidities associated with long-term treatments. We report a case who suffered cardiac arrest due to acute myocarditis developed after initiation of adjuvant treatment.
After completing preoperative chemotherapy and undergoing curative surgery for right breast cancer, a 46-year-old female patient started adjuvant tamoxifen and resumed trastuzumab. Two months later, she complained fever and dyspnea. Blood tests showed a marked increase in hepatic enzymes, and the patient was rushed to our emergency room on suspicion of drug-induced liver injury. In the emergency room, the patient went into cardiac arrest shortly after tachycardia with ST-segment elevation appeared on the monitored electrocardiogram. Resuscitation was started immediately and tracheal intubation, intra-aortic balloon pumping, and extracorporeal membrane oxygenation were started. Coronary angiography results were negative for ischemic heart disease. A diagnosis of fulminant myocarditis was made and steroid pulse therapy and immunoglobulin therapy were started. After the start of treatment, the symptoms of heart failure improved steadily and the patient was discharged on the 28th day. Histological findings of the myocardial biopsy revealed degeneration and necrosis of myocardial cells with marked lymphocytic infiltration, consistent with the histology of lymphocytic myocarditis. Serum cytomegalovirus, coxsackie B virus and adenovirus antibodies were all elevated and these findings were consistent with acute viral myocarditis.
We report a case with strong indications for therapy-induced liver damage, who was ultimately diagnosed with acute viral myocarditis and successfully treated with multidisciplinary therapy. We believe that our findings would be useful for other clinicians in managing similar patients.
随着乳腺癌患者围手术期最佳药物治疗的改善，医生现在必须治疗与长期治疗相关的不良反应和合并症。我们报告一例患者，在辅助治疗开始后因急性心肌炎发生心脏骤停。
一名46岁女性患者在完成术前化疗并接受右乳腺癌根治性手术后，开始服用辅助性他莫昔芬并恢复使用曲妥珠单抗。两个月后，她出现发热和呼吸困难。血液检查显示肝酶显著升高，患者因疑似药物性肝损伤被紧急送往我们的急诊室。在急诊室，患者在监测心电图上出现心动过速伴ST段抬高后不久发生心脏骤停。立即开始复苏，并进行气管插管、主动脉内球囊泵血和体外膜肺氧合。冠状动脉造影结果排除缺血性心脏病。诊断为暴发性心肌炎，并开始使用类固醇冲击疗法和免疫球蛋白疗法。治疗开始后，心力衰竭症状稳步改善，患者在第28天出院。心肌活检的组织学检查结果显示心肌细胞变性和坏死，伴有明显的淋巴细胞浸润，符合淋巴细胞性心肌炎的组织学表现。血清巨细胞病毒、柯萨奇B病毒和腺病毒抗体均升高，这些结果与急性病毒性心肌炎一致。
我们报告一例有强烈治疗性肝损伤指征的病例，最终被诊断为急性病毒性心肌炎，并通过多学科治疗成功治愈。我们相信我们的发现将对其他临床医生管理类似患者有用。
