| Date . | Events . |
|---|---|
| October 2021 | The patient was diagnosed with mixed connective tissue disease (MCTD) and treated with non-steroidal anti-inflammatory drugs and sulfasalazine for arthritis |
| 18 December | Onset of fever, chills, sore throat, and cough |
| 19 December | Sudden onset of chest pain |
| 20 December | Presented to a local hospital with prolonged symptoms |
| Echocardiogram revealed a mildly decreased left ventricular ejection fraction (LVEF; 50%) and small pericardial effusion Admitted to a local hospital with a diagnosis of acute myocarditis | |
| 21 December | LVEF decreased drastically to 20%. Computed tomography revealed mild pulmonary oedema, systemic lymphadenopathy, and hepatosplenomegaly. Cardiac T2-weighted magnetic resonance imaging revealed a slightly high signal intensity in the mid-to-apical myocardium |
| 22 December | Referred to our institution. |
| Blood tests revealed elevated troponin-I, creatinine kinase, and C-reactive protein levels. Coronary angiography revealed no significant stenosis, while right ventricular endomyocardial biopsy revealed mild inflammatory cell infiltration in the cardiac muscle and an absence of eosinophils, giant cells, and granulomas; these were consistent with myocarditis. However, fulminant myocarditis did not seem likely | |
| 24 December | Steroid pulse therapy (1000 mg/day) was initiated because of prolonged fever, chest pain, tachycardia, and new onset of myalgia |
| 25–27 December | LVEF did not improve, and mitral regurgitation became severe. The dobutamine dosage was increased, and diuretics were administered |
| 27 December | Sudden cardiac arrest occurred after crying due to emotional distress Venoarterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pumping (IABP) were initiated |
| 28 December | Prednisolone sodium succinate was initiated (100 mg/day) |
| 29 December | Intravenous cyclophosphamide (IVCY) was initiated (1000 mg) |
| 30 December | LVEF suddenly improved to 40% |
| 31 December | LVEF improved to 50–55%. Successful weaning off of VA-ECMO |
| 1 January 2022 | Withdrawal of IABP |
| 3 January | Successfully extubated without neurological damage |
| 5–27 January | Oral prednisolone dosage was reduced from 60 to 25 mg per week |
| 27 January | Second course of IVCY (500 mg) was initiated |
| 3 February | She was discharged with full walking ability |
| Date . | Events . |
|---|---|
| October 2021 | The patient was diagnosed with mixed connective tissue disease (MCTD) and treated with non-steroidal anti-inflammatory drugs and sulfasalazine for arthritis |
| 18 December | Onset of fever, chills, sore throat, and cough |
| 19 December | Sudden onset of chest pain |
| 20 December | Presented to a local hospital with prolonged symptoms |
| Echocardiogram revealed a mildly decreased left ventricular ejection fraction (LVEF; 50%) and small pericardial effusion Admitted to a local hospital with a diagnosis of acute myocarditis | |
| 21 December | LVEF decreased drastically to 20%. Computed tomography revealed mild pulmonary oedema, systemic lymphadenopathy, and hepatosplenomegaly. Cardiac T2-weighted magnetic resonance imaging revealed a slightly high signal intensity in the mid-to-apical myocardium |
| 22 December | Referred to our institution. |
| Blood tests revealed elevated troponin-I, creatinine kinase, and C-reactive protein levels. Coronary angiography revealed no significant stenosis, while right ventricular endomyocardial biopsy revealed mild inflammatory cell infiltration in the cardiac muscle and an absence of eosinophils, giant cells, and granulomas; these were consistent with myocarditis. However, fulminant myocarditis did not seem likely | |
| 24 December | Steroid pulse therapy (1000 mg/day) was initiated because of prolonged fever, chest pain, tachycardia, and new onset of myalgia |
| 25–27 December | LVEF did not improve, and mitral regurgitation became severe. The dobutamine dosage was increased, and diuretics were administered |
| 27 December | Sudden cardiac arrest occurred after crying due to emotional distress Venoarterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pumping (IABP) were initiated |
| 28 December | Prednisolone sodium succinate was initiated (100 mg/day) |
| 29 December | Intravenous cyclophosphamide (IVCY) was initiated (1000 mg) |
| 30 December | LVEF suddenly improved to 40% |
| 31 December | LVEF improved to 50–55%. Successful weaning off of VA-ECMO |
| 1 January 2022 | Withdrawal of IABP |
| 3 January | Successfully extubated without neurological damage |
| 5–27 January | Oral prednisolone dosage was reduced from 60 to 25 mg per week |
| 27 January | Second course of IVCY (500 mg) was initiated |
| 3 February | She was discharged with full walking ability |
| Date . | Events . |
|---|---|
| October 2021 | The patient was diagnosed with mixed connective tissue disease (MCTD) and treated with non-steroidal anti-inflammatory drugs and sulfasalazine for arthritis |
| 18 December | Onset of fever, chills, sore throat, and cough |
| 19 December | Sudden onset of chest pain |
| 20 December | Presented to a local hospital with prolonged symptoms |
| Echocardiogram revealed a mildly decreased left ventricular ejection fraction (LVEF; 50%) and small pericardial effusion Admitted to a local hospital with a diagnosis of acute myocarditis | |
| 21 December | LVEF decreased drastically to 20%. Computed tomography revealed mild pulmonary oedema, systemic lymphadenopathy, and hepatosplenomegaly. Cardiac T2-weighted magnetic resonance imaging revealed a slightly high signal intensity in the mid-to-apical myocardium |
| 22 December | Referred to our institution. |
| Blood tests revealed elevated troponin-I, creatinine kinase, and C-reactive protein levels. Coronary angiography revealed no significant stenosis, while right ventricular endomyocardial biopsy revealed mild inflammatory cell infiltration in the cardiac muscle and an absence of eosinophils, giant cells, and granulomas; these were consistent with myocarditis. However, fulminant myocarditis did not seem likely | |
| 24 December | Steroid pulse therapy (1000 mg/day) was initiated because of prolonged fever, chest pain, tachycardia, and new onset of myalgia |
| 25–27 December | LVEF did not improve, and mitral regurgitation became severe. The dobutamine dosage was increased, and diuretics were administered |
| 27 December | Sudden cardiac arrest occurred after crying due to emotional distress Venoarterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pumping (IABP) were initiated |
| 28 December | Prednisolone sodium succinate was initiated (100 mg/day) |
| 29 December | Intravenous cyclophosphamide (IVCY) was initiated (1000 mg) |
| 30 December | LVEF suddenly improved to 40% |
| 31 December | LVEF improved to 50–55%. Successful weaning off of VA-ECMO |
| 1 January 2022 | Withdrawal of IABP |
| 3 January | Successfully extubated without neurological damage |
| 5–27 January | Oral prednisolone dosage was reduced from 60 to 25 mg per week |
| 27 January | Second course of IVCY (500 mg) was initiated |
| 3 February | She was discharged with full walking ability |
| Date . | Events . |
|---|---|
| October 2021 | The patient was diagnosed with mixed connective tissue disease (MCTD) and treated with non-steroidal anti-inflammatory drugs and sulfasalazine for arthritis |
| 18 December | Onset of fever, chills, sore throat, and cough |
| 19 December | Sudden onset of chest pain |
| 20 December | Presented to a local hospital with prolonged symptoms |
| Echocardiogram revealed a mildly decreased left ventricular ejection fraction (LVEF; 50%) and small pericardial effusion Admitted to a local hospital with a diagnosis of acute myocarditis | |
| 21 December | LVEF decreased drastically to 20%. Computed tomography revealed mild pulmonary oedema, systemic lymphadenopathy, and hepatosplenomegaly. Cardiac T2-weighted magnetic resonance imaging revealed a slightly high signal intensity in the mid-to-apical myocardium |
| 22 December | Referred to our institution. |
| Blood tests revealed elevated troponin-I, creatinine kinase, and C-reactive protein levels. Coronary angiography revealed no significant stenosis, while right ventricular endomyocardial biopsy revealed mild inflammatory cell infiltration in the cardiac muscle and an absence of eosinophils, giant cells, and granulomas; these were consistent with myocarditis. However, fulminant myocarditis did not seem likely | |
| 24 December | Steroid pulse therapy (1000 mg/day) was initiated because of prolonged fever, chest pain, tachycardia, and new onset of myalgia |
| 25–27 December | LVEF did not improve, and mitral regurgitation became severe. The dobutamine dosage was increased, and diuretics were administered |
| 27 December | Sudden cardiac arrest occurred after crying due to emotional distress Venoarterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pumping (IABP) were initiated |
| 28 December | Prednisolone sodium succinate was initiated (100 mg/day) |
| 29 December | Intravenous cyclophosphamide (IVCY) was initiated (1000 mg) |
| 30 December | LVEF suddenly improved to 40% |
| 31 December | LVEF improved to 50–55%. Successful weaning off of VA-ECMO |
| 1 January 2022 | Withdrawal of IABP |
| 3 January | Successfully extubated without neurological damage |
| 5–27 January | Oral prednisolone dosage was reduced from 60 to 25 mg per week |
| 27 January | Second course of IVCY (500 mg) was initiated |
| 3 February | She was discharged with full walking ability |
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