scholarly journals Case Report: Hypothyroidism Misdiagnosed as Fulminant Myocarditis in a Child

2021 ◽  
Vol 8 ◽  
Author(s):  
Nanjun Zhang ◽  
Shuran Shao ◽  
Yu Yan ◽  
Yimin Hua ◽  
Kaiyu Zhou ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Gamma Globulin ◽  
Hemodynamic Instability ◽  
Fulminant Myocarditis ◽  
Common Disease ◽  
Delay In Diagnosis ◽  
Possible Cause ◽  
Cardiac Enlargement ◽  
Malignant Arrhythmias ◽  
Third Degree Atrioventricular Block

Background: Hypothyroidism can lead to bradycardia, reduced cardiac output, cardiac enlargement, and abnormal electrocardiogram. However, hemodynamic instability and malignant arrhythmias due to hypothyroidism is rarely reported in children.Patient Findings: We report the case of a child with third-degree atrioventricular block, cardiogenic shock, and Adams Stokes Syndrome, who was initially misdiagnosed with fulminant myocarditis and was later found to have hypothyroidism during treatment.Summary: The child's condition did not improve after the administration of gamma globulin, methylprednisolone, and isoproterenol. Even after the placement of temporary pacemakers, the therapeutic effect was still not ideal. Upon reviewing the medical history, the child's condition improved rapidly after levothyroxine supplementation.Conclusions: Hypothyroidism is a common disease, but secondary severe cardiovascular lesions are particularly rare in children. Therefore, the delay in diagnosis can lead to serious cardiovascular manifestations. When pediatric patients develop severe AVB and bradycardia, hypothyroidism should be considered as a possible cause.

scholarly journals New onset diabetes with diabetic ketoacidosis in a child with multisystem inflammatory syndrome due to COVID-19

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Monica N. Naguib ◽  
Jennifer K. Raymond ◽  
Alaina P. Vidmar
Keyword(s):  
Metabolic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Systolic Function ◽  
Hemodynamic Instability ◽  
Case Presentation ◽  
Onset Diabetes ◽  
Potential Trigger ◽  
Inflammatory Syndrome ◽  
New Onset

AbstractIntroductionMultisystem inflammatory syndrome in children (MIS-C) is a unique clinical complication of SARS-CoV-2 infection observed in pediatric patients. COVID-19 is emerging as a potential trigger for the development of diabetes in children. Here, we report a patient presenting with MIS-C and new onset diabetes, and discuss the implication and clinical management of these concomitant conditions.Case presentationAn eight-year-old female presented with hyperglycemia, ketosis and metabolic acidosis consistent with diabetic ketoacidosis (DKA) in the setting of fever, rash, respiratory distress, hemodynamic instability, reduced systolic function with dilation of the left anterior descending artery, and positive SARS-CoV-2 antibodies suggestive of MIS-C.

Giant Cell Myocarditis in Children: Elusive Giant Cells Might Not Be the Only Clue

2021 ◽  
pp. 109352662110449
Author(s):  
Chrystalle Katte Carreon ◽  
Jonathon A. Hagel ◽  
Kevin P. Daly ◽  
Antonio R. Perez-Atayde
Keyword(s):  
Giant Cell ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Giant Cells ◽  
Fulminant Myocarditis ◽  
Giant Cell Myocarditis ◽  
Histopathologic Diagnosis

Giant cell myocarditis (GCM) is a form of fulminant myocarditis that is rapidly progressive and frequently lethal even in children. Over the course of 20 years, a definitive histopathologic diagnosis of GCM has been made at our institution in only two pediatric patients, and in neither instance was the diagnosis of GCM rendered on initial cardiac biopsy. We present the two patients and highlight the similarities in their clinical presentation and their challenging and inconclusive- albeit histologically similar- initial cardiac biopsy findings.

scholarly journals Extracorporeal membrane oxygenation for the support of pediatric patients with acute fulminant myocarditis

2019 ◽  
Vol 61 (6) ◽  
pp. 867
Author(s):  
Güntülü Şık ◽  
Agageldi Annayev ◽  
Asuman Demirbuğa ◽  
Elif Deliceo ◽  
Selim Aydın ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Fulminant Myocarditis ◽  
Membrane Oxygenation

scholarly journals Veno-arterial extracorporeal membrane oxygenation for severe fever with thrombocytopenia syndrome with fulminant myocarditis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Uh. Jin Kim ◽  
Hyukjin Park ◽  
Kye Hun Kim ◽  
Dong Min Kim ◽  
Seung Eun Kim ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Involvement ◽  
Hemodynamic Instability ◽  
Multiple Organ ◽  
Left Ventricular ◽  
Fulminant Myocarditis ◽  
Hemodynamic Support ◽  
Membrane Oxygenation ◽  
Initial Symptoms ◽  
Severe Fever

Abstract Background The clinical spectrum of severe fever with thrombocytopenia syndrome (SFTS) is wide, which can range from fever to multiple organ failure. Conservative therapy plays a key role in the treatment of SFTS. However, severe cases of SFTS, such as fulminant myocarditis, may require mechanical hemodynamic support. Case presentation This report presents a case of a 59-year old woman diagnosed with SFTS by reverse-transcription polymerase chain reaction. The patient had no initial symptoms of cardiac involvement and rapidly developed hemodynamic instability 3 days after hospitalization. She suffered from chest pain and had elevated cardiac enzymes. In the absence of atrio-ventricular conduction abnormalities, left ventricular dysfunction, and coronary artery abnormalities by coronary angiography, she was diagnosed with fulminant myocarditis. At that time, her pulse rate nearly dropped to 0 bpm and she developed near complete akinesia of the heart despite vasopressor administration. Veno-arterial extracorporeal membrane oxygenation (ECMO) was initiated with other supportive measures and she fully recovered after 21 days. Conclusions This case indicates that SFTS can cause fulminant myocarditis even without evidence of cardiac involvement at presentation. When symptoms and/or signs of acute heart failure develop in patients with SFTS, myocarditis should be suspected and the patient should be promptly evaluated. Additionally, mechanical hemodynamic support like ECMO can be a lifesaving tool in the treatment of fulminant myocarditis.

scholarly journals Fulminant Myocarditis: Brief Review

2021 ◽  
Vol 3 (3) ◽  
pp. 01-04
Author(s):  
Ezra A Amsterdam ◽  
Muhammad Majid
Keyword(s):  
Heart Transplantation ◽  
Cardiac Imaging ◽  
Ventricular Arrhythmias ◽  
Early Recognition ◽  
Standard Test ◽  
Fulminant Myocarditis ◽  
Myocardial Inflammation ◽  
Aggressive Management ◽  
Hemodynamic Impairment ◽  
Malignant Arrhythmias

Fulminant myocarditis (FM) is a rare disease characterized by acute hemodynamic impairment and ventricular arrhythmias due to severe myocardial inflammation. It is typically preceded by a viral infection but any of multiple other toxic and infective agents may also be the inciting agent. Diagnosis is based on biomarkers and/or cardiac imaging, but endomyocardial biopsy is the standard test for confirming the diagnosis. FM usually requires therapeutic support of cardiac function and treatment of malignant arrhythmias. Contrary to prior concepts, recent evidence has revealed that patients with FM are more likely to die or need heart transplantation than those with the nonfulminant form of the disease. Early recognition and aggressive management are essential for favorable outcomes.

scholarly journals The Case of Fulminant Myocarditis

Kardiologiia ◽  
2019 ◽  
Vol 59 (9) ◽  
pp. 91-96
Author(s):  
V. A. Titov ◽  
A. A. Shishkova ◽  
L. B. Mitrofanova ◽  
S. V. Ivanova ◽  
D. A. Zverev ◽  
...  
Keyword(s):  
Molecular Genetic ◽  
Screening Method ◽  
Final Diagnosis ◽  
Hemodynamic Instability ◽  
Molecular Genetic Analysis ◽  
Severe Form ◽  
Acute Stage ◽  
Fulminant Myocarditis ◽  
Circulatory Support ◽  
Immunohistochemical Studies

Fulminant myocarditis (FM) is a severe form of inflammatory myocardial injury rapidly developing as acute heart failure, cardiogenic shock, or life-threatening disturbances of cardiac rhythm. FM requires intensive treatment including drug therapy, mechanical circulatory support, and in some cases – heart transplantation. Echocardiography can be used as a screening method of diagnostics. Magnetic resonance imaging of the heart often cannot be performed because of hemodynamic instability of a patient, therefore endomyocardial biopsy with histological and immunohistochemical studies as well as molecular-genetic analysis of obtained samples is required for final diagnosis. Prognosis of the disease is determined by histological picture. In most cases, after cessation of acute stage of the inflammatory process, FM has a favorable long-term prognosis. In this article we present a clinical case of FM and review of current literature on diagnosis and treatment of this disease.

scholarly journals PRESCRIBING TREND AMONG HOSPITALIZED PEDIATRIC PATIENTS IN PRIVATE SECTOR HOSPITAL: A PROSPECTIVE OBSERVATIONAL STUDY IN NADIAD, INDIA

2020 ◽  
pp. 195-198
Author(s):  
SANDIP B PATEL ◽  
YASH P PATEL ◽  
SHISHAV B SHAH
Keyword(s):  
Private Sector ◽  
Pediatric Patients ◽  
Indian Academy ◽  
Essential Medicines ◽  
World Health ◽  
Common Disease ◽  
Treatment Protocols ◽  
Study Results ◽  
Prescribing Trend ◽  
Health Organization

Objectives: Purpose of this study was to analyze the prescription pattern among the hospitalized pediatric patients in private sector hospital. Methods: The study was conducted from January 2018 to April, 2018 at Shaishav Hospital, Nadiad, Gujarat, India, and 178 patients were included into the study. Results were obtained by applying the World Health Organization (WHO) prescribing indicators as well as Indian Academy of Pediatrics List of Essential Medicines (IAP-LEM). Results: During the study period, infectious disease such as pneumonitis, bronchitis, enteric fever, gastroenteritis, and dehydration were the dominant disease among the patients. Average number of drugs per prescription was four but in many of prescription, poly-pharmacy has shown. Antibiotic agents were the most prescribed drug (38.6%) among different classes of drugs. Use of the parenteral route of drug administration was used beyond the range stated by the WHO (59% prescriptions vs. 13–24% WHO range). We found that doctor followed IAP-LEM (in 99.78% cases) for prescribing as well as for dosing also, which was very impressive. Conclusions: As this study indicates, there is a need of development of evidence-based treatment protocols for common disease condition for the rational use of medication, especially for an antibiotic medication.

Procalcitonin in myocarditis patients: role in aetiology identification and risk stratification

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Peretto ◽  
A Villatore ◽  
S Sala ◽  
A Riccio ◽  
M Ripa ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Univariate Analysis ◽  
Fulminant Myocarditis ◽  
Short Term ◽  
Potential Biomarker ◽  
The Mean ◽  
Malignant Arrhythmias

Abstract Background Procalcitonin (PCT) is an established predictor of bacterial infections and sepsis. However, PCT involvement in cardiovascular diseases has been scarcely investigated so far. In particular, no studies at all ever addressed the role of PCT in myocarditis patients. We aimed at evaluating PCT in myocarditis patients, as a potential biomarker of: a) aetiologic diagnosis; b) prognosis. Methods A cohort of 130 consecutive patients with a novel diagnosis of myocarditis confirmed by both endomyocardial biopsy and cardiac magnetic resonance were included in the study. Patients with known bacterial infections or bacterial myocarditis were excluded (n=5). PCT concentration was measured on admission in all patients. Prospective follow-up (FU) was performed every 6 months up to 5 years. Results Of 125 patients analyzed (mean age 45±15 years, males 62%, mean LVEF 48±15%), 22 (18%) had fulminant myocarditis (FM). The remaining 103 cases had non-fulminant myocarditis (NFM), including infarct-like presentation and non-malignant arrhythmias. Aetiology was viral or virus-negative in 23 and 102 patients, respectively. The mean PCT value was 0.44±0.18 mcg/ml, with no significant differences between viral and virus-negative myocarditis (0.43±0.19 vs. 0.44±0.18 mcg/ml, p=0.90). Baseline PCT concentration was significantly higher in FM patients (0.69±0.21 vs. 0.39±0.16 mcg/ml, p=0.07). Consistently, PCT was higher in patients with LVEF <60% (0.51±0.20 vs. 0.30±0.14 mcg/ml, p=0.03) and in those with elevated (>400 pg/mL) NT-proBNP (0.55±0.19 vs. 0.36±0.17 mcg/ml, p=0.03). As for inflammatory biomarkers, patients with high ESR (>20 mm/h) had also higher PCT values (0.56±0.20 vs. 0.37±0.16 mcg/ml, p=0.03). By converse, no association was found between PCT and CRP abnormal values (p>0.05). At univariate analysis, high PCT (≥0.20 mcg/ml) was predictive of heart failure recurrence (OR 2.77, 95% CI 1.18–6.48, p=0.02) or arrhythmic cardiac arrest (OR 3.22, 95% CI 1.19–8.71, p=0.02) by discharge, with overall hospitalization prolonged by 10±4 days (p<0.05). Furthermore, patients with high PCT were more prone to myocarditis recurrences (13/80 vs. 4/45, p=0.03) by 5-year FU. Conclusions In myocarditis patients, elevated PCT values at presentation are not associated with myocarditis aetiology. Nonetheless, PCT suggests a worse short-term clinical outcome, and also a higher risk of myocarditis recurrences at long-term FU. Funding Acknowledgement Type of funding source: None

Acute Appendicitis: Is There a Difference between Children and Adults?

2006 ◽  
Vol 72 (5) ◽  
pp. 409-413 ◽  
Author(s):  
Steven L. Lee ◽  
Hung S. Ho
Keyword(s):  
Acute Appendicitis ◽  
Pediatric Patients ◽  
Age Groups ◽  
Wound Infection Rate ◽  
Negative Appendectomy ◽  
Perforation Rate ◽  
Mortality And Morbidity ◽  
Delay In Diagnosis ◽  
Number Of Patients ◽  
History Of

Historically, the lack of classic symptoms and delay in presentation make diagnosing acute appendicitis more difficult in children, resulting in a higher perforation rate. Despite this, the morbidity of acute appendicitis is usually lower in children. We evaluated the current differences in clinical presentation, diagnostic clues, and the outcomes of acute appendicitis between the two age groups. A retrospective review of 210 consecutive cases of pediatric appendectomy and 744 adult cases for suspected acute appendicitis from January 1995 to December 2000. Pediatric patients were defined as being 13 years and younger. Pediatric patients were similar to adult patients with respect to duration of pain before presentation (2.4 ± 4.3 days vs 2.5 ± 7.3 days), number of patients previously evaluated (22.0 vs 17.7%), number of imaging tests (computed tomography or ultrasound; 32.9 vs 40.2%), and number of patients observed (16.7 vs 17.2%). However, pediatric patients required less time for emergency room evaluation (4.0 ± 2.7 hours vs 5.7 ± 4.9 hours, P = 0.0001). In children and adults, a history of classic, migrating pain had the highest positive predictive value (94.2 vs 89.6%), followed by a white blood cell count ≥12 x 109/L (91.5 vs 84.3%). The overall negative appendectomy rate was 10.0 per cent for children and 19.0 per cent for adults (P = 0.003); the perforation rate was 19.0 per cent and 13.8 per cent, respectively (P > 0.05). The perforation rate in children was not associated with a delay in presentation (perforated cases, 2.9 ± 3.3 days compared with nonperforated cases, 2.3 ± 4.6 days). Mortality and morbidity, including wound infection rate and intra-abdominal abscess rate, were similar. Contrary to traditional teaching, diagnosing acute appendicitis in children is similar to that in adults. A history of migratory pain together with physical findings and leukocytosis remain accurate diagnostic clues for children and adults. Perforation rate and morbidity in children is similar to those in adults. The outcomes of acute appendicitis in children are not associated with a delay in presentation or delay in diagnosis.

Sign in / Sign up

Export Citation Format

Share Document