Life-threatening conditions of uncommon diagnosis: what can be behind multisystem failure?

Excerpt

A 29-year-old woman with a history of high blood pressure during pregnancy consulted the emergency department for angina with blood pressure (BP) of 230/120 mmHg. The interrogation revealed the notion of headaches, palpitations, and sweating for 3 months. On the EKG, there was a junctional escape rhythm with diffuse subepicardial ischemia, transthoracic ultrasound showed hypokinesia with a preserved ejection fraction (61%), and troponins were elevated. Coronary angiography showed a healthy coronary network. The diagnosis of myocarditis was retained. In addition, there was an unrecognized diabetes with fasting blood sugar (FBS) at 1.9 g/l and HbA1c at 7.4%, slight hypokalemia, acute renal failure (serum creatinine at 10 mg/l), as well as an inflammatory syndrome (hyperleukocytosis at 23,000 elements/mm3, sedimentation rate at 60 mm and CRP at 10 mg/l). The thyroid, lipid, hepatic, and hemostasis blood tests were without abnormality. The hypertensive emergency was suppressed by a calcium channel blocker and a converting enzyme inhibitor with a good response. Nevertheless, during her hospitalization, the patient presented paroxysmal hypertensive peaks and left hemiparesis which lasted a few hours (normal cerebral CT). A cardiac magnetic resonance imaging (MRI) was performed 2 weeks later confirming the subacute myocarditis localized to the left ventricle. …