Myocarditis presenting as gastritis in children.
Vomiting and abdominal pain are common pediatric complaints encountered by emergency physicians. The differential diagnosis of abdominal pain is extensive. Herein, we report 2 cases with fatal myocarditis who initially presented with abdominal pain and vomiting. Both cases were presented with abdominal pain, vomiting, and loose stools. On arrival at our emergency department, hypotension, tachycardia, and cyanotic extremities were found. Their serum troponin-I levels were elevated. The echocardiogram demonstrated poor left ventricular performance and a decreased ejection fraction. In both cases, an arrhythmia and a coma developed within hours and were shortly followed by death. The clinical presentations of acute myocarditis are variable, ranging from an initial mild discomfort to acute progressive heart failure, and at times, even death. Abdominal pain may be a manifestation of systemic disease, an extra-abdominal lesion, or myocarditis. Although myocarditis associated with abdominal pain or vomiting remains a diagnostic challenge to physicians, it should be considered in the differential diagnosis of children with gastritis and hypotension or who are refractory to rehydration therapy.
Chang
Yi-Jung
YJ
Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tauyuan, Taiwan.
Chao
Hsun-Chin
HC
Hsia
Shao-Hsuan
SH
Yan
Dah-Chin
DC
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005756:Gastritis / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis*; D014839:Vomiting / Q000209:etiology