Recently, City Children’s Hospital received a 4-month-old NVQN child, female, living in Binh Thuan. Taking the medical history, the child was sick for about 1 day, with a low fever, no feeding, tired breathing, lethargy, spitting milk, purple lips, purple hands and feet without convulsions, diarrhea 1 time with yellow, non-bloody stools, admitted to a local hospital, noted that the child was disturbed, fever 38.5oC, purple lips, cyanosis of extremities, cool extremities CRT lasts > 3 seconds, pulse 190 l/min light, tachycardia gallop, chest concave breathing 50 l/min, SpO2 86%, blood test white blood cell count 9,400/mm3, Troponin I 910 pg/ml (normally less than 3 pg/ml), chest X-ray with enlarged heart, intubated to help with breathing, using vasopressor dopamine, dobutamine, transferred to Children’s Hospital City. Here, the child was sedated, pale lips / squeezing balls, SpO2 difficult to measure, cool extremities, radial pulse difficult to catch the heart, faint breathing, few erythematous nodules on the soles of left foot, no sore throat, echocardiogram showed Cardiac enlargement mainly left ventricle, contractility reduced EF 33%, FS 14%, arterial blood gas test showed severe metabolic acidosis, blood lactate increased due to tissue hypoperfusion, cardiac enzymes Troponin I, CK -MB were all elevated, liver enzymes AST, ALT increased, diagnosed with cardiogenic shock fulminant myocarditis, re-intubation, mechanical ventilation, infusion of vasopressors Adrenanin 0.1 mcg/kg/min, dopamine 12 mcg /kg/min, dobutamine 10mcg/kg/min. The child’s hemodynamic status worsened, continued to use vasopressors and was consulted for intravenous infusion of immunoglobulins. Results after nearly 2 weeks of treatment, the child’s condition gradually improved, the myocardial contractility returned to normal, was weaned from the ventilator, and was quite awake.
This is a rare case of infantile fulminant myocarditis saved by circulatory support and immunoglobulin administration. Parents should note that in the cold season of Christmas and New Year, children may have viral myocarditis, so it is necessary to prevent and keep children warm, have adequate nutrition, age appropriate, moderate activities, scheduled vaccinations and save If your child has symptoms of fever, vomiting, abdominal pain, fatigue, fainting, refusing to eat or drink, pale skin, etc., please take them to a medical facility for the doctor to examine to rule out potential diseases such as myositis. heart disease, encephalitis, appendicitis, dengue fever, hand, foot and mouth disease,
BS CK2. Nguyen Minh Tien
City Children’s Hospital
