ABSTRACT
A 36-year-old female with a high-grade fever and epigastric abdominal pain was prescribed antibiotics, but developed hypoxia and dyspnea. An echocardiography revealed diffuse hypokinesis and massive pericardial effusion, after which diagnostic cardiac catheterization and an endomyocardial biopsy (EMB) were peformed to reveal fibrosis and infiltration of inflammation cells composed primarily of neutrophils. Clinical manifestation of a spiking fever, leukocytosis, elevated ferritin levels, skin rash and EMB findings led to a diagnosis of adult-onset Still's disease (AOSD) with acute myocarditis. Pulse therapy of intravenous methylprednisolone was performed for three days, followed by a daily dose of prednisone (60 mg). After a course of steroid therapy for fever and pericardial effusion, and conducting a left ventricular ejection fraction, the patient showed improvement and was discharged asymptomatic within 32 days of admission. This study is the first to report on a case of myocarditis in AOSD diagnosed by neutrophil infiltration in the myocardium.
Subject(s)
Adult , Female , Humans , Abdominal Pain , Hypoxia , Anti-Bacterial Agents , Biopsy , Cardiac Catheterization , Cardiac Catheters , Diagnosis , Dyspnea , Echocardiography , Exanthema , Ferritins , Fever , Fibrosis , Heart Failure , Inflammation , Leukocytosis , Magnetic Resonance Imaging , Methylprednisolone , Myocarditis , Myocardium , Neutrophil Infiltration , Neutrophils , Pericardial Effusion , Prednisone , Still's Disease, Adult-Onset , Stroke VolumeABSTRACT
1) All the medical schools in France are public, and the admission is open to almost all the qualifieds tudents. However, the number of students allowed to advance to the clinical education is strictly limited.<BR>2) Clerkship similar to the one in the USA is mandatory in the last two years of medical school. The students take care of inpatients under meticulous supervision by residents and attending staff.<BR>3) Postgraduate training of generalists emphasizes the importance of experiencing sufficient number of outpatients under supervision, so that the residents become competent to work as independent practitioners in three years.<BR>4) Specialty trainings are balanced with mixtures of inpatient care, outpatient care and procedures. The number of residency positions is determined to provide of enough opportunities in each aspect of the education