Acute heart failure in meningococcal disease due to myocarditis and sepsis

CASE REPORT:

Healthy 26 years-old male comes to the emergency department;

History: sore throat, fever, headache, nausea/vomiting and malaise for 2 days;

Physical exam: stable vital signs, no respiratory distress, warm, nuchal rigidity, normal pupils and

no neurologic deficit. Normal cardiac / pulmonary auscultation.

Exams: Labs (high WBC, creatinine, lactate), CXR, Head CT (diffused edema),

LP (CSF w/ low glucose, high protein, diplococci gram negative -> Neisseria meningitidis)

2155

L. Celia Petersen, TR. Reichert, CVE. Drebes, JS. Jardim, SVG. Wanderley, M. Crecenzio, M. Wiehe, LC. Bodanese, JCVC. Guaragna, LC. Danzmann Hospital São Lucas / PUC-RS, Cardiology, Porto Alegre-RS, Brazil

INTRODUCTION:

Acute heart failure -> syndrome with different aetiologies

(cardiac vs non-cardiac)

-> context of infection: myocarditis vs sepsis.

=> The patient becomes less responsive with hemodynamic compromise, non-responsive to volume infusion.

=> Intubation - MV, noradrenaline infusion, ceftriaxone, dexametasone.

=> ECG was done and Cardiology (resident) was called at 2:00am:

=> Point of care (bedside) ultrasound was done:

Dx: Acute heart failure – Sepsis

Myocarditis – meningococcal meningoencephalitis (max. troponin 8.660pg/ml)

FOLLOW-UP:

ICU -> pupura-fulminans / atrial fibrillation

Discharged after 20 days -> sinus rhythm, normal EF, no deficit.

DISCUSSION:

The use of point of care ultrasound to define shock aetiology;

Sepsis induced myocardial dysfunction;

Myocarditis = 50% meningoccocal disease;

DDx: ACS (hyperdynamic + coagulation)

Myocardial dysfunction indicates a higher

Incidence of fatal outcome in meningococcal

disease… not in this case!

REFERENCES: 1- Gore I, Saphir O. Myocarditis; a classification of 1402 cases. Am Heart J 1947; 34: 827. 2- Boucek MM, Boerth RC, Artman M, et al. Myocardial dysfunction in children with acute meningococcemia. J Pediatr 1984; 105:538. 3- Merx MW, Weber C. Sepsis and the heart. Circ 2007; 116: 793-802. 4- Leslie T, Cooper Jr. Myocarditis Review. N Engl J Med 2009;360:1526-38.