You Binquan, Zeng Congjun, Wang Bingyin
Department of Cardiology, Kowloon Hospital, Shanghai Jiaotong University, School of Medicine, 118 Wansheng Street, Suzhou 215000, China.
Department of Imaging, Kowloon Hospital, Shanghai Jiaotong University, School of Medicine, Suzhou 215000, China.
Eur Heart J Case Rep. 2023 Jul 13;7(8):ytad302. doi: 10.1093/ehjcr/ytad302. eCollection 2023 Aug.
Early myocardial calcifications secondary to fulminant myocarditis (FM) are rare, and their natural evolution and effects on cardiac function are poorly understood. Here, we followed the patient for 4 years to observe the development of cardiac calcification and its impact on heart function.
A 16-year-old man was hospitalized with a fever and cough for 1 day. The patient was previously healthy and had no history of heart disease or specific family conditions. The patient was positive for anti-Epstein-Barr virus IgG and IgM. The computed tomography (CT) scan showed no coronary lesions. Cardiogenic shock and recurrent ventricular fibrillation developed on the third day after admission, and the patient received rescue therapy such as endotracheal intubation, defibrillation, extracorporeal membrane oxygenation, and corticosteroids. On the 13th day of admission, a CT scan revealed significant calcification in the left ventricular wall. The patient was discharged after 30 days in the hospital. After discharge, his left ventricular calcification peaked at 6 months and gradually subsided after that, and his left ventricular function slowly returned to normal at 12 months.
In younger patients, myocardial calcifications secondary to FM may occur as early as 13 days and affect cardiac function. After proper treatment and rehabilitation, the patient's myocardial calcification can gradually subside and the cardiac function can gradually recover. For FM patients, timely and comprehensive intensive treatment, including heart, lung, and kidney replacement therapy and early administration of hormone preparations, may be beneficial to the early recovery of patients.
暴发性心肌炎（FM）继发的早期心肌钙化罕见，其自然演变及对心脏功能的影响尚不清楚。在此，我们对该患者进行了4年随访，以观察心脏钙化的发展及其对心脏功能的影响。
一名16岁男性因发热、咳嗽1天入院。患者既往健康，无心脏病史或特殊家族情况。抗EB病毒IgG和IgM阳性。计算机断层扫描（CT）显示无冠状动脉病变。入院后第3天出现心源性休克和反复室颤，患者接受了气管插管、除颤、体外膜肺氧合及皮质类固醇等抢救治疗。入院第13天，CT扫描显示左心室壁有明显钙化。患者住院30天后出院。出院后，其左心室钙化在6个月时达到峰值，此后逐渐消退，左心室功能在12个月时缓慢恢复正常。
在年轻患者中，FM继发的心肌钙化可能早在13天就出现并影响心脏功能。经过适当治疗和康复，患者的心肌钙化可逐渐消退，心脏功能可逐渐恢复。对于FM患者，及时、全面的强化治疗，包括心、肺、肾替代治疗及早期使用激素制剂，可能有利于患者早期康复。
