• PDF / 170,659 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 74 Downloads / 219 Views

DOWNLOAD

REPORT

---

1 S

Fulminant myocarditis: case report A 14-year-old girl developed fulminant myocarditis following vaccination with influenza-A-H1N1-H3N2-influenza-B-YamagataVictoria-vaccine-Novartis vaccine [dosage not stated]. The girl, who had cardiopulmonary arrest, was referred to a hospital. Seven days prior to the referral, she had received an injection of influenza-A-H1N1-H3N2-influenza-B-Yamagata-Victoria-vaccine-Novartis vaccine [inactivated influenza vaccine containing the influenza A-H1N1 virus, the influenza A-H3N2 virus, the influenza B-Yamagata lineage virus and the influenza B-Victoria lineage virus] (the vaccine also contained thimerosal as a preservative to prevent bacterial contamination). Five days after the vaccination, she developed nausea, fever, chest pain and sore throat. Two days after the presentation of symptoms, she complained of faintness, and her mother took her to an emergency clinic, where she suddenly collapsed. Her cardiac rhythm showed pulseless wide QRS tachycardia. Electrical cardioversion with cardiopulmonary resuscitation was attempted, but restoration of spontaneous circulation was not achieved. The girl was transported to hospital (current presentation) and venoarterial extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumping (IABP) were started immediately. Echocardiography showed mild pericardial effusion, left ventricular wall thickening with diminution of the cavity and general hypokinesis with dyssynchrony (left ventricular ejection fraction [LVEF] was 16%). Laboratory data showed an elevated creatine phosphokinase level of 1431 U/L with an increase of troponin T level to 8.25 ng/mL. Coronary artery angiography did not reveal coronary artery disease. Histological analyses of endomyocardial biopsy specimens showed massive infiltration of CD3- and CD68-positive cells and various degrees of cardiomyocyte necrosis; however, infiltration of eosinophils and giant cells was not noted. Based on histopathological findings, a diagnosis of lymphocytic myocarditis (fulminant myocarditis) was made. Her hemodynamic status improved gradually. A repeated echocardiography showed an improvement of LVEF to 40% and left ventricular wall thickening. On day 11, the IABP and ECMO were removed. A lymphocyte transformation test was positive for the influenza vaccine: a stimulation index of 939% (reference range