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Jung, Lee, Lee, Lee, Kim, and Lee: Acute Fulminant Myocarditis Recovered from Electro-Mechanical Dissociation in Scrub Typhus
Case Report

The Ewha Medical Journal 2016; 39(1): 1-5.

Published online: 29 January 2016

DOI: https://doi.org/10.12771/emj.2016.39.1.1

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

Young Hak Jung, Minjoo Lee, Kyoung Hwa Lee, Ji Hoon Lee, Seok-hyung Kim, Byoung Kwon Lee

Department of Internal Medicine, Yonsei University Gangnam Severance Hospital, Seoul, Korea.

Corresponding author Byoung Kwon Lee. Cardiology Division, Department of Internal Medicine, Yonsei University Gangnam Severance Hospital, 211 Eonju-ro, Gangnamgu, Seoul 06273, Korea. Tel: 82-2-2019-3307, Fax: 82-2-3463-3882, cardiobk@yuhs.ac

Received 6 July 2015       Accepted 20 August 2015

Copyright © 2016, The Ewha Medical Journal

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Scrub typhus, Myocarditis, Extracorporeal circulation

Figures and Tables

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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