RESUMEN
We report, through this observation, a rare case of Wegener's disease revealed by myocarditis associated with fibroblastic endocarditis. The patient was initially admitted to hospital with global heart failure. The ECG showed atrial flutter rhythm disorder. Echocardiographic examination revealed non-dilated left ventricle with severe dysfunction and positive troponin dosage. Severe renal failure was discovered fortuitously and required hemodialysis. It was associated with an inflammatory anaemia confirmed by serum ferritin and myelogram. c-ANCA dosage was strongly positive, confirming the diagnosis. Chest CT scanning objectified right basal pneumonia. After starting appropriate treatment, including corticotherapy and immunosuppressive treatment, evolution was favorable with the normalization of left ventricular systolic function. Although obvious clinical cardiac events are rare, cardiac involvement in Wegener's disease is described, requiring rapid diagnostic orientation and rigorous knowledge of this serious disease.
Asunto(s)
Endocarditis/etiología , Granulomatosis con Poliangitis/diagnóstico , Miocarditis/etiología , Corticoesteroides/uso terapéutico , Ecocardiografía , Endocarditis/tratamiento farmacológico , Granulomatosis con Poliangitis/tratamiento farmacológico , Granulomatosis con Poliangitis/fisiopatología , Insuficiencia Cardíaca/diagnóstico , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Miocarditis/tratamiento farmacológico , Diálisis Renal/métodos , Insuficiencia Renal/etiología , Insuficiencia Renal/terapia , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Izquierda/etiologíaRESUMEN
Ilio-caval fistula is a rare complication of lumbar disk surgery that may pose a real diagnostic challenge. We report a case of a 50-year-old woman with overlooked massive right ilio-caval fistula complicating lumbar surgery 6 years previously, and who presented with refractory right heart failure misdiagnosed as chronic pericarditis. The combination of right heart failure and a periumbilical murmur should alert clinicians to investigate with the appropriate imaging tests to confirm the diagnosis.