History

A 27-year-old man was admitted to the emergency department with fever and thoracic pain. In the previous 6 months, the patient lost a substantial amount of weight (12 kg). His family history was negative for cardiac disease. Electrocardiography revealed sinus rhythm and diffuse T-wave inversion. Two-dimensional echocardiography was performed and revealed normal left systolic function (ejection fraction, 60%). Laboratory tests showed elevated levels of high-sensitivity cardiac troponin (1.07 ng/mL; normal value, <0.015 ng/mL), high levels of C-reactive protein (16 mg/dL; normal range, 0–5 mg/dL), and leukocytosis with an eosinophilia level of 8710/μL (normal level, <400/μL). Parasitic and infectious diseases (Toxocara canis, strongyloides, filariasis, cysticercosis, fasciola, trichinella, echinococcosis) were excluded based on blood and fecal test results. Corticosteroid therapy was started, and the patient was dismissed. A few days later, he was readmitted to the emergency department with a headache and suddenly blurred vision. Neurologic and ophthalmologic findings were normal, and MRI of the brain was performed. Cardiac MRI was performed 2 days later and revealed the following quantitative results: (a) left ventricular end-diastolic volume (LVDV) of 165 mL (LVDV/body surface area [BSA], 89 mL/m²; normal range, 64–100 mL/m²), left ventricular end-systolic volume (LVSV) of 80 mL (LVSV/BSA, 43 mL/m²; normal range, 17–39 mL/m²), stroke volume (SV) of 85 mL (SV/BSA, 46 mL/m²; normal range, 43–67 mL/m²), and ejection fraction of 52% and (b) right ventricular end-diastolic volume (RVDV) of 163 mL (RVDV/BSA, 88 mL/m²; normal range, 63–111 mL/m²), right ventricular end-systolic volume (RVSV) of 81 mL (RVSV/BSA, 44 mL/m²; normal range, 32–92 mL/m²), stroke volume (SV) of 82 mL (SV/BSA, 44 mL/m²; normal range, 39–71 mL/m²), and ejection fraction of 50%.

中文翻译：

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病例 305：洛夫勒心内膜炎

历史

一名 27 岁男子因发烧和胸痛被送入急诊科。在过去的 6 个月中，患者体重减轻了很多（12 公斤）。他的家族史对心脏病是阴性的。心电图显示窦性心律和弥漫性 T 波倒置。二维超声心动图显示左收缩功能正常（射血分数，60%）。实验室检查显示高敏心肌肌钙蛋白水平升高（1.07 ng/mL；正常值，<0.015 ng/mL），C 反应蛋白水平升高（16 mg/dL；正常范围，0-5 mg/dL）和白细胞增多，嗜酸性粒细胞增多水平为 8710/μL（正常水平，<400/μL）。寄生虫和传染病（犬弓蛔虫、类圆线虫、丝虫病、囊尾蚴病、片形吸虫病、旋毛虫病、包虫病）根据血液和粪便检测结果排除。开始皮质类固醇治疗，患者被解雇。几天后，他因头痛和视力突然模糊而再次入院。神经系统和眼科检查结果正常，并进行了脑部 MRI 检查。2 天后进行心脏 MRI，显示以下定量结果：(a)左心室舒张末期容积 (LVDV) 为 165 mL（LVDV/体表面积 [BSA]，89 mL/m ²；正常范围，64– 100 mL/m ² )，左心室收缩末期容积 (LVSV) 为 80 mL（LVSV/BSA，43 mL/m ²；正常范围，17–39 mL/m ²)，每搏输出量 (SV) 为 85 mL（SV/BSA，46 mL/m ²；正常范围，43–67 mL/m ²），射血分数为 52% 和(b)右心室舒张末期容积 ( RVDV) 163 mL (RVDV/BSA, 88 mL/m ²；正常范围，63–111 mL/m ² )，右心室收缩末期容积 (RVSV) 81 mL (RVSV/BSA, 44 mL/m ²；正常范围，32–92 mL/m ² )，每搏输出量 (SV) 为 82 mL（SV/BSA，44 mL/m ²；正常范围，39–71 mL/m ²），射血分数为 50% .