Min Su Hyon

Epstein–Barr virus-induced acute myocarditis diagnosed using cardiac magnetic resonance imaging

A15-year-old boy came to the emergency room complaining of general weakness that had started 2 days previously. He was relatively healthy. For the last 5 days, he had suffered from intermittent vomiting, watery diarrhea, and mild febrile sensation. Then, the general weakness developed. On physical examination, his blood pressure was 80/60 mmHg, pulse was 60 beats/min, respiratory rate was 20 breaths/min, and body temperature was 36 °C. The laboratory revealed an increased leukocyte count of 12,100/L. On echocardiography, the left ventricle was not dilated, but systolic function was markedly reduced with an ejection fraction of about 30%. No regional wall motion abnormality was observed. He was treated under the impression of myocarditis and admitted to the intensive care unit. Four hours after admission, an intermittent generalized tonic–clonic convulsion occurred. A complete atrioventricular block with a ventricular rate about 25 beats/min developed and was managed with insertion of a temporary transvenous pacemaker. Emergency brain computed tomography revealed no abnormality and the seizure stopped spontaneously. The level of myocardial enzymes showed an increase: troponin T, 9.24 ng/mL (normalb0.1 ng/dL); creatine kinase MB isoenzyme, 70 ng/mL; myoglobin, 127 ng/mL. We also

Contact dermatitis caused by ambulatory blood pressure monitoring

A 63-year-old housewife who had diabetes came to the outpatient clinic for evaluation of labile hypertension. She had undergone a total thyroidectomy 8 years earlier to treat papillary thyroid cancer. She had no history of allergy to any medicine or food. Twenty-four-hour ambulatory blood pressure monitoring was done. After this test, she developed a pruritic erythematous patch on her upper arm, which had been in contact with the blood pressure cuff (Fig. 1). Contact dermatitis after ambulatory blood pressure monitoring has not been reported. She complained markedly about this unexplained complication, which improved after treatment with antihistamines and topical steroid cream.

Fatal massive and recurring pulmonary embolism followed by thrombocytopenia developed after heparin and warfarin treatment in a patient with metastatic breast cancer with an incidental large right atrial thrombus.

A thromboembolic complication such as pulmonary embolism in patients who had cancer and mobile thrombi in the heart is a rare but fatal complication. Surgical thromboembolectomy is considered as the classical treatment of choice. In case of inoperable patient, catheter-directed therapy may be an alternative treatment. We report an interesting case of metastatic breast cancer with a large and mobile right atrial thrombus complicated by a massive and subsequently recurring pulmonary embolism, followed by thrombocytopenia developed after heparin and warfarin treatment.

Development of Brugada Syndrome Following Photodynamic Therapy in a Patient with Cholangiocarcinoma

Brugada syndrome can be unmasked by several conditions including a febrile state, marked leukocytosis, and electrolyte disturbances. Herein, we describe a 62-year-old man with cholangiocarcinoma in the first reported case of Brugada syndrome onset following photodynamic therapy.