-また、急性心筋梗塞に類似した心筋炎を伴う心筋炎を発症することもあります

-associated myocarditis mimicking acute myocardial infarction.

• Othmane Mohib
• Philippe Clevenbergh
• Carine Truyens
• Marielle Morissens
• José Castro Rodriguez

抄録

背景 トリキネラ症は、トリキネラ属の線虫による寄生感染症であり、主な感染経路は、汚染された生肉や調理不足の肉を摂取することである。トリキネラ症の心臓病変はまれであるが，最も頻度の高い死因となっている．ここでは、トリチネラ症に関連した心筋炎が心筋梗塞を模擬した1例を報告する。症例概要 既往歴のない35歳のアフリカ人男性が、放射線を伴わない安静時の圧迫感を訴えて救急外来を受診した。入院時に施行された心電図は再分極の非特異的変化を示した。血液検査ではトロポニンTが高値を示し，好酸球性白血球症が優勢であった．経胸腔心エコー検査を行ったところ，駆出率は維持されたままで左室同心肥大が認められた．中隔壁、下壁、心内膜は低皮化していた。好酸球性心筋炎で入院した．好酸球増多の原因を調べたところ，血清学的には強く陽性であった．関連性心筋炎と診断された．アルベンダゾール-プレドニゾロン二重療法で治療し，臨床的・生物学的に良好な結果を得た．結論 トリキネラ症の臨床的疑いは，典型的な臨床症状と好酸球性心筋炎の存在に関連した疫学に基づいている．好酸球性心筋炎はトリチネラ症の重篤な合併症であり、リズム障害により死に至る可能性がある。胸痛、トロポニンの増加、心電図異常などは、心筋梗塞をまねき、臨床医に誤解を与える要素である。略語 ANCA：抗好中球細胞質抗体、ANA：抗核抗体、ECDC.ECG：心電図、ELISA：酵素免疫吸着法、EMF：心筋内膜線維症、ES：排泄物-分泌物、ICT。トリチネラ症に関する国際委員会；ＭＲＩ．MRI: Magnetic Resonance Imaging（磁気共鳴画像法）。

Background Trichinellosis is a parasitic infection caused by nematodes of the genus , and its principal mode of transmission is the consumption of raw or undercooked contaminated meat. Cardiac involvement in trichinellosis is unusual, yet it represents the most frequent cause of death. Here, we report a case in which -associated myocarditis simulated a myocardial infarction. Case presentation A 35-year-old African man with no previous medical history was admitted to the emergency department for acute substernal discomfort at rest described as a pressure with no radiation. The electrocardiogram performed upon admission showed non-specific alterations of repolarization. Blood biology revealed high levels of troponin T and predominant eosinophilic leukocytosis. A transthoracic echocardiography was carried out and found a significant left ventricular concentric hypertrophy with a preserved ejection fraction. The septal and inferior walls, as well as the endocardium were hyperechogenic. The patient was hospitalized for eosinophilic myocarditis. The cause of hypereosinophilia was investigated, and a serology came back strongly positive. A diagnosis of associated-myocarditis was made. The patient was treated with albendazole-prednisolone dual therapy with favorable clinical and biological outcomes. Conclusion The clinical suspicion of trichinellosis is based on suggestive epidemiology associated with the typical clinical presentation and the presence of eosinophilia. Eosinophilic myocarditis is a severe complication of trichinellosis which can result in death due to rhythm disorders. Chest pain, increase in troponins, and electrocardiographic abnormalities are all elements that can mimic a myocardial infarction and mislead clinicians. Abbreviations ANCA: Anti-Neutrophil Cytoplasmic Antibodies; ANA: Anti-Nuclear Antibodies; ECDC: European Centre for Disease Prevention and Control; ECG: Electrocardiogram; ELISA: Enzyme-Linked ImmunoSorbent Assay; EMF: Endomyocardial Fibrosis; ES: Excretory-Secretory; ICT: International Commission on Trichinellosis; MRI: Magnetic Resonance Imaging.