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Case Report

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
The Ewha Medical Journal 2016;39(1):1-5. Published online: January 29, 2016

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: July 6, 2015   • Accepted: August 20, 2015

Copyright © 2016, The Ewha Medical Journal

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.

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  • 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
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  • 2. Levine HD. Pathologic study of thirty-one cases of scrub typhus fever with especial reference to the cardiovascular system. Am Heart J 1946;31:314-328.
  • 3. Yotsukura M, Aoki N, Fukuzumi N, Ishikawa K. Review of a case of tsutsugamushi disease showing myocarditis and confirmation of Rickettsia by endomyocardial biopsy. Jpn Circ J 1991;55:149-153.
  • 4. Han DJ, Park HS, Kim DY, Kang HC, Rhee HS, Lee SW, et al. Acute fulminant myocarditis following scrub typhus infection. Korean J Med 2013;85:623-628.
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  • 6. Brown GW, Shirai A, Rogers C, Groves MG. Diagnostic criteria for scrub typhus: probability values for immunofluorescent antibody and Proteus OXK agglutinin titers. Am J Trop Med Hyg 1983;32:1101-1107.
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  • 10. Sittiwangkul R, Pongprot Y, Silviliarat S, Oberdorfer P, Jittamala P, Sirisanthana V. Acute fulminant myocarditis in scrub typhus. Ann Trop Paediatr 2008;28:149-154.
  • 11. Park JJ, Cho HJ. Mechanical circulatory support for advanced heart failure. Korean J Med 2015;88:142-149.
Fig. 1

The initial chest X-ray shows increased interstitial markings in both lung fields, mediastinal widening and cardiomegaly.

emj-39-1-g001.jpg
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.

emj-39-1-g002.jpg
Fig. 3

Changes in cardiac markers―(A) creatinine kinase, (B) creatinine kinase-MB and troponin I―and (C) ejection fraction.

emj-39-1-g003.jpg
Fig. 4

On the 4th day of hospitalization, electrocardiography shows atrioventricular dissociation (A). After improvement, electrocardiography shows normal atrio-ventricular conduction (B).

emj-39-1-g004.jpg
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.

emj-39-1-g005.jpg

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Comprehensive review on cardiac manifestation of scrub typhus
      Barath Prashanth Sivasubramanian, Abul Hasan Shadali Abdul Khader, Diviya Bharathi Ravikumar, Francis Vino Dominic Savio, Umabalan Thirupathy, Varshini Thiruvadi, Rhea Prasad, Hema Thokala, Husna Qadeer, Dhiraj Poragal Venkataperumal, Ashima Gupta, Nagara
      Frontiers in Tropical Diseases.2024;[Epub]     CrossRef
    • Case Report: Fulminant Myocarditis Successfully Treated With Extracorporeal Membrane Oxygenation in Ikeda Strain Orientia tsutsugamushi Infection
      Hyejin Park, Yongwhan Lim, Min Chul Kim, Seong Eun Kim, In-Seok Jeong, Yoo Duk Choi, Dong-Min Kim
      Frontiers in Cardiovascular Medicine.2021;[Epub]     CrossRef
    • A case report of scrub typhus complicated with myocarditis and rhabdomyolysis
      Young-Jae Ki, Dong-Min Kim, Na-Ra Yoon, Sung-Soo Kim, Choon-Mee Kim
      BMC Infectious Diseases.2018;[Epub]     CrossRef

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    Acute Fulminant Myocarditis Recovered from Electro-Mechanical Dissociation in Scrub Typhus
    Ewha Med J. 2016;39(1):1-5.   Published online January 29, 2016
    DOI: https://doi.org/10.12771/emj.2016.39.1.1
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    • Citation for the content below
    Acute Fulminant Myocarditis Recovered from Electro-Mechanical Dissociation in Scrub Typhus
    Ewha Med J. 2016;39(1):1-5.   Published online January 29, 2016
    DOI: https://doi.org/10.12771/emj.2016.39.1.1
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    Acute Fulminant Myocarditis Recovered from Electro-Mechanical Dissociation in Scrub Typhus
    Image Image Image Image Image
    Fig. 1 The initial chest X-ray shows increased interstitial markings in both lung fields, mediastinal widening and cardiomegaly.
    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.
    Fig. 3 Changes in cardiac markers―(A) creatinine kinase, (B) creatinine kinase-MB and troponin I―and (C) ejection fraction.
    Fig. 4 On the 4th day of hospitalization, electrocardiography shows atrioventricular dissociation (A). After improvement, electrocardiography shows normal atrio-ventricular conduction (B).
    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.

    Fig. 1

    Fig. 2

    Fig. 3

    Fig. 4

    Fig. 5

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