Fulminant Myocarditis due to Chlamydia pneumoniae Complicated with Peripheral Gangrene and Cerebral Infarction: A Case Report

Chlamydia pneumoniae引起的猛暴性心肌炎，併發末梢肢體發紺、腦部血管阻塞：一病例報告

高寶鑽(Pao-Tsuan Kao) ； 姜智殷(Chin-Yen Chiang)

《內科學誌》 20卷2期 (2009/04) Pp. 155-161

https://doi.org/10.6314/JIMT.2009.20(2).07

摘要

一位患有上呼吸道感染曾接受過流感疫苗注射的女性病患，病發猛暴性心肌炎，導致心臟衰竭、心因性休克及呼吸衰竭，且併發末梢肢體發紺、腦部血管阻塞。Chlamydia pneumoniae引起的心肌炎是少見的，須藉由急性期及恢復期血清來診斷。猛暴性心肌炎在臨床上不易被診斷出來，但仍需高度懷疑及且排除其他可能原因（例如心肌梗塞），作爲鑑別診斷的依據。猛暴性心肌炎可經由適當抗生素及心臟支持療法，使病患獲得治癒，但此個案已產生合併症，且末梢肢體接受截肢手術。

並列摘要

A woman who had recently had a respiratory tract infection and later received influenza immunization developed myocarditis secondary to Chlamydia pneumoniae. She presented with acute heart failure, and developed cardiogenic shock and acute respiratory failure. Her course was complicated by gangrene of the extremities and cerebral infarction. C. pneumoniae is an unusual cause of myocarditis and was implicated in this case on the basis of acute and convalescent serologic testing. Even the diagnosis of myocarditis is difficult to make, it requires a high index of suspicion and diagnostic testing aimed at excluding other diagnoses, such as myocardial infarction. Recovery may be complete, although our patient was left with residual deficits with gangrene of the extremities and cerebral infarction.

並列關鍵字

Chlamydia pneumoniae ； Fulminant myocarditis ； Paired serum ； Peripheral gangrene ； Cerebral infarction