Acute severe myocarditis with cardiac thrombus formation ─ A therapeutic challenge

Authors

  • Isabel Ayres Pereira Department of Pediatrics, Centro Hospitalar Vila Nova de Gaia e Espinho
  • Cláudia Teles-Silva Department of Pediatrics, Centro Hospitalar Universitário de São João https://orcid.org/0000-0003-2263-5229
  • Edite Serrano Gonçalves Department of Cardiology Pediatrics, Centro Materno Pediátrico, Centro Hospitalar Universitário de São João
  • Teresa Cunha da Mota Department of Pediatric Intensive Medicine, Centro Materno Pediátrico, Centro Hospitalar Universitário de São João https://orcid.org/0000-0001-9073-6895
  • Maria de Lurdes Lisboa Sequeira Department of Pediatric Intensive Medicine, Centro Materno Pediátrico, Centro Hospitalar Universitário de São João https://orcid.org/0000-0002-7198-6255
  • António Augusto Batista Ribeiro Department of Pediatric Intensive Medicine, Centro Materno Pediátrico, Centro Hospitalar Universitário de São João

DOI:

https://doi.org/10.25753/BirthGrowthMJ.v31.i2.20844

Keywords:

Campylobacter, cardiac transplant, intracardiac thrombus, myocarditis, thrombectomy

Abstract

Acute myocarditis is a potentially life-threatening disease in pediatric age, with risk of severe cardiac dysfunction and intracardiac thrombus formation.
A previously healthy 16-year-old boy was admitted to the Pediatric Intensive Care Unit with suspicion of acute myocarditis with multiorgan dysfunction. He reported mucous diarrhea, vomiting, and asthenia with one week of evolution. The echocardiogram revealed moderate-to-severe left ventricle dysfunction with mitral and tricuspid regurgitation and two hyperechoic images suggestive of thrombus, later confirmed by cardiac magnetic resonance. Unfractionated heparin was started on admission. Campylobacter jejuni was isolated from feces. Despite treatment, the clinical picture worsened with systemic arterial embolization. Surgical thrombectomy was performed on day 13, and extracorporeal membrane oxygenation (ECMO) was maintained until day 28. At this time, the boy was submitted to orthotopic cardiac transplantation with favorable postoperative course.
The therapeutic approach in these cases is controversial and should always be multifactorial and multidisciplinary. Despite the inherent risk of complications, thrombectomy should be considered when conservative approaches fail.

Downloads

Download data is not yet available.

References

Nugent AW, Daubeney PE, Chondros P, Carlin JB, Cheung M, Wilkinson LC, et al. The epidemiology of childhood cardiomyopathy in Australia. The New England journal of medicine. 2003;348(17):1639-46.

Canter CE, Simpson KE. Diagnosis and treatment of myocarditis in children in the current era. Circulation. 2014;129(1):115-28.

Lin KY, Kerur B, Witmer CM, Beslow LA, Licht DJ, Ichord RN, et al. Thrombotic events in critically ill children with myocarditis. Cardiology in the young. 2014;24(5):840-7.

Dechant MJ, Siepe M, Stiller B, Grohmann J. Surgical thrombectomy of two left ventricular thrombi in a child with acute myocarditis. Pediatrics. 2013;131(4):e1303-7.

Abu-Kishk I, Baram S, Kozer E, Klin B, Eshel G. Thrombophilia, left ventricular dysfunction and intracardiac thrombi in children. Korean circulation journal. 2011;41(8):453-7.

Cetin, II, Ekici F, Unal S, Kocabas A, Sahin S, Yazici MU, et al. Intracardiac thrombus in children: the fine equilibrium between the risk and the benefit. Pediatric hematology and oncology. 2014;31(5):481-7.

Fay K, Maher K, Kogon B. Pediatric intracardiac thrombus: a diagnostic and therapeutic dilemma. Congenital heart disease. 2013;8(5):E157-60.

Pac FA, Cagdas DN. Treatment of massive cardiac thrombi in a patient with protein C and protein S deficiency. Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis. 2007;18(7):699-702.

Gutierrez de la Varga L, Rodriguez Suarez ML, Corros Vicente C. Myocarditis associated with Campylobacter jejuni infection. Medicina clinica. 2017;148(7):333-4.

Kratzer C, Wolf F, Graninger W, Weissel M. Acute cardiac disease in a young patient with Campylobacter jejuni infection: a case report. Wiener klinische Wochenschrift. 2010;122(9-10):315-9.

Heinzl B, Kostenberger M, Nagel B, Sorantin E, Beitzke A, Gamillscheg A. Campylobacter jejuni infection associated with myopericarditis in adolescents: report of two cases. European journal of pediatrics. 2010;169(1):63-5.

Greenfield GM, Mailey J, Lyons K, Trouton TG. Acute myocarditis secondary to acute Campylobacter jejuni infection. Clinical medicine. 2018;18(1):98-9.

Pena LA, Fishbein MC. Fatal myocarditis related to Campylobacter jejuni infection: a case report. Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology. 2007;16(2):119-21.

Turpie DF, Forbes KJ, Hannah A, Metcalfe MJ, McKenzie H, Small GR. Food-the way to a man’s heart: a mini-case series of Campylobacter perimyocarditis. Scandinavian journal of infectious diseases. 2009;41(6-7):528-31.

John JB, Cron SG, Kung GC, Mott AR. Intracardiac thrombi in pediatric patients: presentation profiles and clinical outcomes. Pediatric cardiology. 2007;28(3):213-20.

Downloads

Published

2022-06-30

How to Cite

1.
Ayres Pereira I, Teles-Silva C, Serrano Gonçalves E, Cunha da Mota T, de Lurdes Lisboa Sequeira M, Augusto Batista Ribeiro A. Acute severe myocarditis with cardiac thrombus formation ─ A therapeutic challenge. REVNEC [Internet]. 2022Jun.30 [cited 2022Aug.12];31(2):166-71. Available from: https://revistas.rcaap.pt/nascercrescer/article/view/20844

Issue

Section

Case Reports