RESUMO
INTRODUCTION: Viral myocarditis can emerge with various symptoms, including fatal arrhythmia and cardiogenic shock, potentially evolving in chronic myocarditis or dilatative cardiomyopathy. We report a case of a kidney transplant patient affected by coxsackie viral myocarditis. METHODS: A 49-year-old man was admitted to our hospital with dyspnea and fever in August 2014. He underwent living donor kidney transplantation in 1986 and polar graft resection for papillary carcinoma in 2012. RESULTS: The initial investigation showed pulmonary congestion, pancreatitis, increased serum troponin I, and increased liver enzyme levels. Echocardiogram revealed an ejection fraction (EF) of 20% and PAPS 45 mm Hg. He underwent coronary stent implantation, started hemodialysis, and continued on low-dose steroid immunosuppressive therapy. The clinical course improved rapidly, but endomyocardial biopsy showed acute myocarditis. Further investigation revealed a high antibody titer against coxsackievirus B4 and B5. Pancreatic enzyme levels normalized 2 months after patient admission; his cardiac condition improved after 6 months. The patient has been followed for 1 year, and his left ventricular EF is stable (45%). CONCLUSIONS: Viral myocarditis represents a serious clinical condition requiring a fast therapeutic intervention. This patient's clinical course suggests that changes in his immunosuppressive therapy were associated with progressive amelioration of his viral myocarditis.
Assuntos
Doença da Artéria Coronariana/diagnóstico , Infecções por Coxsackievirus/diagnóstico , Insuficiência Cardíaca/diagnóstico , Transplante de Rim , Miocardite/diagnóstico , Pancreatite/diagnóstico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Viroses/diagnóstico , Doença Aguda , Biópsia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/terapia , Infecções por Coxsackievirus/complicações , Ecocardiografia , Ecocardiografia Doppler em Cores , Febre/etiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Miocardite/complicações , Miocardite/virologia , Pancreatite/etiologia , Stents , Disfunção Ventricular Esquerda/etiologia , Viroses/complicaçõesRESUMO
it is difficult to diagnose because of its nonspecific presentation. This condition frequently occurs in association with an extreme physical stress and may lead to acute adrenal insufficiency or death if not promptly and properly treated. We report a rare case of acute bilateral adrenal hemorrhage with adrenal insufficiency following duodenopancreatectomy for ampulloma in absence of surgical complications. Early diagnosis and corticosteroid replacement with aggressive management of the precipitating pathology are essential to enable a successful outcome.