Infective rhomboencephalitis and inverted Takotsubo: neurogenic-stunned myocardium or myocarditis?

Here we originally describe the clinical scenario of a young immune-competent patient affected by acute rhomboencephalitis with severe parenchymal edema and acute hydrocephalus who developed sudden life-threatening cardiac derangement. Hemodynamic and perfusion parameters revealed cardiogenic shock,...

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Bibliographic Details
Published in:The American journal of emergency medicine 2014-02, Vol.32 (2), p.191.e1-191.e3
Main Authors: Ruggieri, Francesco, Cerri, Marco, Beretta, Luigi
Format: Article
Language:English
Subjects:
Adult
Biopsy
Brain - pathology
Cardiology
Cardiomyopathy
Diagnosis, Differential
Echocardiography
Emergency
Emergency medical care
Encephalitis - complications
Encephalitis - diagnosis
Encephalitis - microbiology
Female
Heart attacks
Humans
Illnesses
Infections
Intensive care
Listeria
Listeria monocytogenes
Listeriosis - complications
Listeriosis - microbiology
Magnetic Resonance Imaging
Medical instruments
Myocardial Stunning - complications
Myocardial Stunning - diagnosis
Myocardial Stunning - microbiology
Myocarditis - complications
Myocarditis - diagnosis
Myocarditis - microbiology
Neuroimaging
Pulmonary arteries
Rhombencephalon - microbiology
Takotsubo Cardiomyopathy - complications
Takotsubo Cardiomyopathy - diagnosis
Tomography
Viral infections
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Summary:Here we originally describe the clinical scenario of a young immune-competent patient affected by acute rhomboencephalitis with severe parenchymal edema and acute hydrocephalus who developed sudden life-threatening cardiac derangement. Hemodynamic and perfusion parameters revealed cardiogenic shock, so intensive circulatory support with epinephrine infusion and intra-aortic balloon pump was needed to restore organ perfusion. Transesophageal echocardiographic examination showed severe left ventricular dysfunction (ejection fraction as low as 20%) with wall motion abnormalities resembling a pattern of Takotsubo-inverted cardiomyopathy. Cultural investigations revealed infection by Listeria monocytogenes. Nevertheless, her conditions rapidly improved, and she had full cardiac recovery within few days. Acute cerebral damage, pattern of echocardiographic wall motion abnormalities, and clinical course may suggest neurogenic stunned as pathological mechanism responsible for cardiac dysfunction, but differential diagnosis with acute myocarditis is to be considered too. Acute cardiogenic shock during the course of rhomboencephalitis by L monocytogenes has not been yet reported; prompt clinical suspicion and intensive care are needed to manage this life-threatening condition.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2013.08.047