title: [Takotsubo cardiomyopathy thought to be induced by MRSA meningitis and cervical epidural abscess in a maintenance-hemodialysis patient: case report].
abstract: A 65-year-old man was admitted to our hospital for high fever and severe left shoulder pain. He was initiated on maintenance hemodialysis for end-stage renal failure caused by diabetic nephropathy 9 years previously. On admission, the serum CRP level was 29.3 mg/d/l and the white blood cell count was 29,000/mm3. Bacterial examination of blood and spinal fluid revealed MRSA colonization. On the 6th hospital day, a giant negative T wave in the V2-6 leads of an electrocardiogram asymptomatically appeared. Ultracardiogram revealed apical systolic paradoxical centrifugal motion. None of the cardiogenic enzymes, such as creatine kinase, lactate dehydrogenase and glutamic oxaloacetic transaminase was elevated. Cardiac thallium-201-chloride (201Tl-Cl) and I-123 beta-metyl iodophenyl-pentadecanoic acid (123I-BMIPP) scintigraphy revealed a decreased accumulation of isotopes in the apex. From these findings, we diagnosed Takotsubo cardiomyopathy induced by MRSA meningitis. Vancomycin was administrated and the inflammatory signs decreased. On the 46th hospital day, tetraplegia and respiratory suppression occurred. A cervical spinal magnetic resonance image revealed cervical spondylodiscitis and cervical epidural abscess, which compressed the medulla oblongata. Surgical spinal decompression and drainage of the abscess were performed. The giant negative T wave in the electrocardiogram improved after the operation. Two months after the operation, cardiac 201Tl-Cl scintigraphy revealed improvement in the accumulation of isotopes in the apex. Takotsubo cardiomyopathy is secondary cardiomyopathy presenting with apical systolic paradoxical centrifugal motion without coronary stenotic disease. It has been reported to be induced by severe mental stress or intracranial disease. In the present patient, it was predicted that stress on the central nerve system caused by the MRSA meningitis and the cervical epidural abscess induced the Takotsubo cardiomyopathy.
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kusaba
authors.forename: Hiroyo
authors.initials: H
authors.lastname: Sasaki
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sakurada
authors.forename: Shingo
authors.initials: S
authors.lastname: Kuboshima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miura
authors.forename: Jun
authors.initials: J
authors.lastname: Okabayashi
authors.forename: Mei
authors.initials: M
authors.lastname: Murao
authors.forename: Goro
authors.initials: G
authors.lastname: Imai
authors.forename: Sayuri
authors.initials: S
authors.lastname: Shirai
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Konno
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Shima
authors.forename: Goichi
authors.initials: G
authors.lastname: Ogimoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Yasuda
authors.forename: Takeo
authors.initials: T
authors.lastname: Sato
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kimura
mesh_terms: D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology*; D004562:Electrocardiography; D020802:Epidural Abscess / Q000150:complications* / Q000382:microbiology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000382:microbiology*; D016106:Methicillin Resistance; D008875:Middle Aged; D009333:Neck; D006435:Renal Dialysis / Q000009:adverse effects*; D013203:Staphylococcal Infections; D013211:Staphylococcus aureus