Acute ventricular wall thickening: sepsis, thrombotic microangiopathy, or myocarditis?

Nicolas De Schryver,Philippe Hantson,Diego Castanares-Zapatero,Delphine Hoton

doi:10.1155/2015/275825

Nicolas De Schryver, Philippe Hantson + Show 2 more

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https://doi.org/10.1155/2015/275825

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Abstract

Background. Acute myocardial oedema has been documented in experimental models of ischemia-reperfusion injury or sepsis and is usually investigated by magnetic resonance imaging. Purpose. We describe a case of acute ventricular wall thickening documented by echocardiography in a patient developing sepsis and thrombotic microangiopathy. Case Description. A 40-year-old woman, with a history of mixed connective tissue disease, was admitted with laryngeal oedema and fever. She developed Streptococcus pneumoniae septicaemia and subsequent laboratory abnormalities were consistent with a thrombotic microangiopathy. Echocardiography revealed an impressive diffuse thickening of the whole myocardium (interventricular septum 18 mm; posterior wall 16 mm) with diffuse hypokinesia and markedly reduced left ventricular ejection fraction (31%). There was also a moderate pericardial effusion. Echocardiography was normal two months before. The patient died from acute heart failure. Macroscopic and microscopic examination of the heart suggested that the ventricular wall thickening was induced by oedematous changes, together with an excess of inflammatory cells. Conclusion. Acute ventricular wall thickening that corresponded to myocardial oedema as a first hypothesis was observed at echocardiography during the course of septicaemia complicated by thrombotic microangiopathy.

Highlights

The rapid development of ventricular thickening at echocardiography is suggestive of interstitial oedema rather than muscular hypertrophy
We discuss the possible mechanisms of acute ventricular thickening in a complex case of combined septicaemia, thrombotic microangiopathy (TMA), and mixed connective tissue disease (MCTD)
A 40-year-old Black African woman presented to the hospital for rapid onset of facial swelling and dysphagia. Her medical history included a mild form of MCTD diagnosed in 2006 (Sharp’s syndrome with anti-DNA and anti-RNP antibodies), three previous episodes of angioneurotic oedema, two recent episodes of septicaemia (Streptococcus agalactiae and pneumoniae), and a tuboovarian abscess treated by laparoscopic drainage 2 months before

Summary

Background

Acute myocardial oedema has been documented in experimental models of ischemia-reperfusion injury or sepsis and is usually investigated by magnetic resonance imaging. We describe a case of acute ventricular wall thickening documented by echocardiography in a patient developing sepsis and thrombotic microangiopathy. A 40year-old woman, with a history of mixed connective tissue disease, was admitted with laryngeal oedema and fever. She developed Streptococcus pneumoniae septicaemia and subsequent laboratory abnormalities were consistent with a thrombotic microangiopathy. Macroscopic and microscopic examination of the heart suggested that the ventricular wall thickening was induced by oedematous changes, together with an excess of inflammatory cells. Acute ventricular wall thickening that corresponded to myocardial oedema as a first hypothesis was observed at echocardiography during the course of septicaemia complicated by thrombotic microangiopathy

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