Influenza‐associated septic shock accompanied by septic cardiomyopathy that developed in summer and mimicked fulminant myocarditis

Figures

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  Figure 1. Radiological studies, electrocardiogram, and transthoracic echocardiography on admission of a 34‐year‐old man with influenza‐associated septic shock accompanied by septic cardiomyopathy. A, Chest X‐ray taken at a previous hospital did not show pulmonary involvement. B, Chest X‐ray on admission to our hospital shows rapidly progressed pulmonary edema with cardiomegaly. C, Electrocardiogram shows sinus tachycardia and diffuse ST segment elevation. D, Transthoracic echocardiography shows severely decreased left ventricular (LV) function and LV dilatation (ejection fraction, 20%; LV end‐systolic diameter, 66 mm). However, unlike typical cases of fulminant myocarditis, myocardial edema was not detected. E, Myocardial biopsy findings do not show inflammatory cell infiltration or necrosis of cardiomyocytes and do not indicate fulminant myocarditis.

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  Figure 2. Clinical course of the case of a 34‐year‐old man with influenza‐associated septic shock accompanied by septic cardiomyopathy during the first week. Peramivir (300 mg/day for 2 days) combined with a vasopressor was initiated, and the patient was stabilized in the first 72 h. In contrast to fulminant myocarditis, his cardiac index was preserved on admission. Daily examination of the ejection fraction as measured by an echocardiogram showed gradual improvement and almost returned to normal in the following 2 weeks. BT, body temperature; CPK, creatine phosphokinase; CRP, C‐reactive protein; EF, ejection fraction; HR, heart rate; sBP, systolic blood pressure; WBC, white blood cell count.