Ewha Med J.  2016 Jan;39(1):1-5. 10.12771/emj.2016.39.1.1.

Acute Fulminant Myocarditis Recovered from Electro-Mechanical Dissociation in Scrub Typhus

• Jung YH
• Lee M
• Lee KH
• Lee JH
• Kim SH
• Lee BK

• KMID: 2152749
• DOI: http://doi.org/10.12771/emj.2016.39.1.1

Abstract

Scrub typhus, caused by Orientia tsutsugamushi, is an acute febrile illness. Characteristics of tsutsugamushi disease are fever, rash and eschar. However, severe complications might rarely occur, such as acute fulminant myocarditis caused by scrub typhus. Thus, there are few reports of recovery from seriously complicated cases. We report on an adult male with scrub typhus complicated with acute fulminant myocarditis with no previous comorbid illness who recovered successfully with proper treatment including antibiotics, ventilator support, percutaneous cardiopulmonary support, and continuous renal replacement therapy.

Keyword

Scrub typhus; Myocarditis; Extracorporeal circulation

MeSH Terms

Adult
Anti-Bacterial Agents
Exanthema
Extracorporeal Circulation
Fever
Humans
Male
Myocarditis*
Orientia tsutsugamushi
Renal Replacement Therapy
Scrub Typhus*
Ventilators, Mechanical
Anti-Bacterial Agents

Figure

• 

  Fig. 1 The initial chest X-ray shows increased interstitial markings in both lung fields, mediastinal widening and cardiomegaly.

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  Fig. 2 Electrocardiography on admission shows sinus tachycardia, right bundle branch block, ST depression in lead II, III aVF, and ST elevation in lead V1-3.

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  Fig. 3 Changes in cardiac markers―(A) creatinine kinase, (B) creatinine kinase-MB and troponin I―and (C) ejection fraction.

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  Fig. 4 On the 4th day of hospitalization, electrocardiography shows atrioventricular dissociation (A). After improvement, electrocardiography shows normal atrio-ventricular conduction (B).

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  Fig. 5 During the follow up period, chest X-ray shows pleural effusion and pulmonary edema and cardiomegaly, and aggravation for about a week. After three weeks of admission, clinical improvement has been observed and chest X-ray shows improvement of pleural effusion and pulmonary edema and cardiomegaly. On the (A) 4th, (B) 8th, (C) 19th day of hospitalization.

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