Hypoperfusion With Vomiting, Abdominal Pain, or Dizziness and Convulsions: An Alert to Fulminant Myocarditis in Children

Angang Zhu

Tian Zhang

Xiaobi Hang

Xiaoguang Zhang

Yingying Xiong

Tao Fang

Mingwu Chen

^{Department of Pediatrics, Anhui Provincial Hospital, Wannan Medical College, Hefei, China}

^{Department of Pediatrics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China}

^{Department of Pediatrics, Anhui Provincial Children's Hospital, Hefei, China}

^{Division of Life Sciences and Medicine, Department of Pediatrics, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, University of Science and Technology of China, Hefei, China}

Edited by: Hongfang Jin, Peking University First Hospital, China

Reviewed by: Lijian Xie, Shanghai Children's Hospital, China; Yusheng Pang, First Affiliated Hospital of Guangxi Medical University, China

*Correspondence: Mingwu Chen moc.621@10uwgnimnehc

This article was submitted to Pediatric Cardiology, a section of the journal Frontiers in Pediatrics

†These authors share first authorship

Edited by: Hongfang Jin, Peking University First Hospital, China

Reviewed by: Lijian Xie, Shanghai Children's Hospital, China; Yusheng Pang, First Affiliated Hospital of Guangxi Medical University, China

Received 2020 Jan 31; Accepted 2020 Mar 30.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Abstract

Objective: To investigate the clinical features, treatment methods, and outcomes of fulminant myocarditis (FM) in children.

Methods: The clinical data of 23 children with FM hospitalized in the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (Anhui Provincial Hospital) and Anhui Provincial Children's Hospital from January 2011 to September 2019 were retrospectively analyzed.

Results: Among the 23 patients analyzed, 10 were male and 13 were female. The patients aged from 6 months to 14 years old (6.5 ± 3.4 years), and 18 patients were over 3 years old. There were 14 cases with respiratory symptoms, 16 cases with gastrointestinal symptoms, 15 cases with neurological symptoms, and 19 cases with hypoperfusion manifestations. Creatine kinase MB (CK-MB) and cardiac troponin I (CTnI) levels were increased in 19 and 21 cases, respectively. Electrocardiography (ECG) showed ST-T changes in 18 cases and atrioventricular blocks (AVB) in 15 cases. Echocardiography (ECHO) showed cardiac chamber enlargement (CCE) in eight cases, left ventricular systolic dysfunction in five cases, decrease in left ventricular ejection fraction (LVEF) in four cases, reduction in wall motion in two cases, and pericardial effusion in seven cases. Intravenous immunoglobulin (IVIG) and glucocorticoids were administered to 19 and 20 patients, respectively. Fourteen patients were treated with temporary pacemakers, one patient received extracorporeal membrane oxygenation (ECMO), one patient received continuous renal replacement therapy (CRRT), and one patient received ECMO combined with CRRT. Twenty patients improved at discharge, and three patients died.

Conclusion: Preschool and school-age children showing hypoperfusion symptoms, such as paleness, cold, clammy limbs, and capillary refill time (CRT) extension, accompanied by vomiting, abdominal pain, dizziness, convulsions, and other symptoms, should be carefully examined for FM. CK-MB, CTnI, ECG, and echocardiogram need to be performed at the earliest opportunity. In the early stages of FM, vital signs should be actively monitored, high-dose IVIG and glucocorticoids should be administered, and life support technologies such as temporary pacemakers, ECMO, and CRRT should be used to increase the survival rate of children with FM as needed.

Keywords: hypoperfusion, fulminant, myocarditis, children, retrospective analysis

Abstract

Acknowledgments

We would like to thank the patients and their families for their generous participation in this study.

Acknowledgments

Footnotes

Funding. The study was supported by the Natural Science Foundation of Anhui Province (grant no. 21608085MH196).

Footnotes

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