Fulminant myocardial failure in a previously healthy young man.

Abstract

### History A 15-year-old boy was admitted to the intensive care unit of our institution in early November 1992 because of rapidly progressive heart failure with fever. The patient was a secondary school pupil, living with his parents and his brother, all of whom were well and resided in a city suburb, spending occasional weekends in the country. There was no family history of heart disease. The boy had no cardiovascular risk factors, history of intravenous drug abuse, or risk factors for human immunodeficiency virus. The patient had undergone an appendectomy 8 years earlier. He had been exposed to a parturient cat in July 1992, and his brother had been hospitalized for 2 days in October 1992 for unexplained fever and abdominal pain. The patient had been well until 7 days earlier, when headaches and fever occurred. Three days later, he developed a cough, followed by upper abdominal discomfort and vomiting. The general practitioner diagnosed an acute bronchitis and prescribed oral amoxicillin. At that time, physical examination and cardiac auscultation were noted as normal. Over the course of the following days, the patient became dyspneic and was admitted to the hospital. ### Initial Clinical Findings On admission the boy was pale and anxious. He had pyrexia of 38°C, a heart rate of 120 beats per minute, a respiratory rate of 30 breaths per minute, and a blood pressure of 110/82 mm Hg. Physical examination revealed an S3 sound with a 2/6 precordial murmur. Bibasilar inspiratory crackles were also present; the liver extended 3 cm below the right costal margin, and the jugular veins were distended to 10 cm above the sternal angle. No peripheral edema, cyanosis, rash, or lymphadenopathy was found. The abdominal and neurological examinations were normal. Most of the laboratory findings, including white blood cell count, hemoglobin, platelets, erythrocyte sedimentation rate, C-reactive protein, …