Zhang Xinyuan, Guo Yingkun, Xu Huayan
Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
Front Cardiovasc Med. 2024 Sep 3;11:1419496. doi: 10.3389/fcvm.2024.1419496. eCollection 2024.
Cardiovascular complications are the leading cause of death among individuals with Duchenne muscular dystrophy (DMD). However, due to the difficulty in evaluating individuals with inactive DMD, acute myocardial injury may be overlooked.
An 11-year-old boy with DMD presented to the emergency department with a 5-day history of persistent nasal congestion, runny nose, and cough. He was regularly taking prednisolone acetate, angiotensin-converting enzyme (ACE) inhibitors, and β-blockers for suspected DMD-associated cardiomyopathy. Upon presentation, a substantially elevated cardiac troponin I (cTnI) level of 19.8 μg/L and abnormal electrocardiogram (ECG) results were detected. Further cardiac magnetic resonance imaging (CMR) showed myocardial inflammation with localized T2 hyperintensity from the basal to middle lateral and inferior walls, as well as late gadolinium enhancement (LGE) from the basal to apical inferior lateral walls, supporting a diagnosis of acute myocarditis. Subsequently, the patient showed clinical improvement in response to combination treatment with intravenous immunoglobulin, oral prednisolone acetate, potassium chloride sustained-release tablets, anti-heart failure medication, and broad-spectrum antibiotics.
We report a rare case of acute myocarditis in a patient with DMD, potentially due to upper respiratory tract infection. This case highlights the importance of early myocarditis recognition and treatment in patients with DMD.
心血管并发症是杜氏肌营养不良症（DMD）患者的主要死因。然而，由于评估非活动期DMD患者存在困难，急性心肌损伤可能被忽视。
一名11岁的DMD男孩因持续鼻塞、流涕和咳嗽5天就诊于急诊科。他因疑似DMD相关心肌病而定期服用醋酸泼尼松龙、血管紧张素转换酶（ACE）抑制剂和β受体阻滞剂。就诊时，检测到心肌肌钙蛋白I（cTnI）水平大幅升高至19.8μg/L，心电图（ECG）结果异常。进一步的心脏磁共振成像（CMR）显示心肌炎症，从基底到中侧壁和下壁出现局部T2高信号，以及从基底到心尖下侧壁的晚期钆增强（LGE），支持急性心肌炎的诊断。随后，患者在接受静脉注射免疫球蛋白、口服醋酸泼尼松龙、氯化钾缓释片、抗心力衰竭药物和广谱抗生素联合治疗后临床症状改善。
我们报告了一例DMD患者罕见的急性心肌炎病例，可能由上呼吸道感染引起。该病例强调了早期识别和治疗DMD患者心肌炎的重要性。
