Acute myocarditis in bodybuilder from coxsackievirus and thyrotoxicosis

Publication date: Available online 20 July 2016 Source:Journal of Cardiology Cases Author(s): Tommy Kwak, Moamen Al Zoubi, Aruni Bhavith, Carlos Rueda Rios, Surender Kumar A 25-year-old male with no past medical history presented with 1 day of chest pain. The patient had exercised with high intensity for a bodybuilding competition. He had fever, malaise, sore throat, and cough 1 week before presentation. He was tachycardic and tachypneic. Cardiac examination was unremarkable. Electrocardiogram showed diffuse ST segment elevation. Laboratory results showed leukocytosis, creatinine kinase 3078unit/L, and troponin I 78.06ng/mL. Coronary angiography revealed no occlusion. Echocardiogram showed ejection fraction of 45% with global hypokinesis. The next day, the patient became dyspneic, hypoxic, and hypotensive. Chest X-ray showed pulmonary edema requiring intubation for respiratory failure. Inotropic support and intra-aortic balloon pump were started. A viral panel was ordered and antibody titer of coxsackievirus B type 4 was ≥1:640. On obtaining further history, it was found that he took liothyronine 75mcg daily for 3 weeks. Thyroid-stimulating hormone was 0.015U/mL and free T3 was 4.4ng/mL. Burch–Wartofsky score was 75. Methimazole and hydrocortisone were started. Cardiac magnetic resonance imaging showed diffuse myocardial inflammation and edema. There was multifocal dense epicardial and midmyocardial necrosis in all segments. The patient was discharged on met...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research