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OP-075 Fulminant myocarditis associated with ebstein-barr virus infection complicated with III-degree atrioventricular block in 4-year-old girl
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  1. Eliza Cinteza1,
  2. Ruxandra Vidlescu1,
  3. Mihai Manciu2,
  4. Dan Stefan2,
  5. Ionel Armat2,
  6. Cosmin Gora2,
  7. Monica Popescu2,
  8. Irina Margarint2,
  9. Radu Vatasescu1,
  10. Alin Nicolescu2
  1. 1„Carol Davila’ University of Medicine and Pharmacy
  2. 2„Marie Curie’ Emergency Children’s Hospital, Bucharest, Romania

Abstract

Aim Myocarditis is a rare cardiac pathology that may present in pediatric practice with common clinical signs such as fever, abdominal pain, and rhinorrhea. Ebstein Barr virus etiology is extremely rare among myocarditis cases. Cardiac complete block and ventricular arrhythmias may rarely but severely complicate myocarditis.

Material and Method To assess the evolution in a rare complicated case of fulminant myocarditis.

Results Case report: A 4-year-old girl was admitted to the Pediatric Department of our hospital for fever, abdominal pain, and nasal obstruction, symptoms that started three days prior. In the first 24 hours after admission to the Pediatrics clinic, the patient‘s clinical condition gradually deteriorated, becoming bradycardic, 45/min, and hypotensive, BP 75/45 mmHg. During the cardiac evaluation, echocardiography revealed severe systolic dysfunction, and the electrocardiogram showed complete atrioventricular block and significant ST-segment elevation in leads V1-V5, and aVL, associated with ST-segment depression in leads DII, DII, aVF, and V6. The patient was transferred to the Department of Cardiac Intensive Care for monitoring and treatment. She received Isoproterenol, Dobutamine, Lisinopril, Spironolactone, Dexamethasone, 0.5 mg/kg/day. We decided to go for pulse therapy with methylprednisolone, in parallel with immunoglobulin, without any improvement. We have tried also Anakinra, 4 mg/kg/day, for ten days, but without recovering from AV bloc. She manifested frequent ventricular bigeminy and one non-sustained ventricular tachycardia. During hospitalization, the evolution was slowly favorable both from the clinical and echocardiographic point of view. In the context of the exhaustion of pharmacological resources, after three weeks from onset, permanent cardiac stimulation was decided and a VVI RM-compatible pacemaker was implanted over the epicardium with a good response.

Conclusions Fulminant myocarditis associated with Ebstein-Barr virus infection is a rare but potentially deadly situation. Careful clinical examination may avoid aggravation of severe complications at the beginning of the onset and save lives. A step-by-step approach was considered with good result.

  • complete atrioventricular block
  • fulminant myocarditis
  • Ebstein Barr Virus infection
  • IV immunoglobulin
  • Anakinra

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