J Neurocrit Care.  2022 Jun;15(1):46-51. 10.18700/jnc.210032.

Takotsubo syndrome and myasthenic crisis after radiocontrast media-induced anaphylaxis: a case report

• Cho JH
• Kim H
• Yum J

• KMID: 2531999
• DOI: http://doi.org/10.18700/jnc.210032

Abstract

Background
Takotsubo syndrome and myasthenic crisis can be triggered by physical stress. We present the case of a woman who developed Takotsubo syndrome and myasthenic crisis following radiocontrast media-induced anaphylaxis.
Case Report
A 39-year-old woman presented with diplopia and ptosis. After chest computed tomography scan, her consciousness was stupor and her oxygen saturation decreased. Electrocardiography showed ST elevation, and cardiac enzyme levels increased. Echocardiography revealed severe left ventricular dysfunction. Myasthenia gravis was diagnosed based on anti-acetylcholine receptor antibody and repetitive nerve stimulation test. Extubation failed, and her weakness worsened. Her neurological condition gradually improved after steroid therapy. Repeat echocardiography demonstrated complete recovery of left ventricular dysfunction.
Conclusion
Takotsubo syndrome can be triggered by anaphylaxis and can occur in patients with neurological disorders; therefore, neurologists need to know about this disorder. The combination of Takotsubo syndrome and myasthenic crisis is rare, but may be associated with a poor prognosis.

Keyword

Takotsubo cardiomyopathy; Anaphylaxis; Contrast media; Myasthenia gravis

Figure

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  Fig. 1. Serial electrocardiogram (ECG). (A) ECG before anaphylaxis revealed normal findings with normal sinus rhythm. (B) ECG immediately after anaphylaxis showed ST elevation in lead I, II, aVL, and V2-5. (C) ECG on day 3 of hospitalization showed dynamic changes with marked T-wave inversion and prolonged QTc interval. aVR, augmented vector right; aVL, augmented vector left; aVF, augmented vector foot; QTc, corrected QT interval.

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  Fig. 2. Serial transthoracic echocardiography (TTE). (A) TTE demonstrated severe global hypokinesia of left ventricular (LV) base, akinesia of mid-LV to apex without thinning, and reduced LV systolic function. (B) Repeat TTE showed complete recovery of LV dysfunction.

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