Survival after acute necrotizing eosinophilic myocarditis complicating a massive left ventricular mural thrombus: a case report.

An 81-year-old man was referred to our hospital with exertional dyspnea following cold-like symptoms. Electrocardiography revealed ST elevation and positive T wave in leads I, II, aVL, aVF, and V2-V6. The diagnosis was acute myocarditis complicating heart failure. He was conservatively managed. On hospital day 8, brain infarction developed and echocardiography disclosed massive mural thrombus in the left ventricle. Left ventriculotomy was performed on hospital day 21 and histological examination showed inflammatory cell infiltration mainly composed of eosinophils and monocytes, degeneration of myocytes with replacement fibrosis, and fresh fibrin thrombus overlaying the endocardium. These findings were compatible with a diagnosis of acute necrotizing eosinophilic myocarditis(ANEM). He recovered uneventfully without specific therapy. This case suggests that a subtype of ANEM might be self-limiting.

Myxedema ascites with an extremely elevated CA125 Level: a case report.

Carbohydrate antigen 125 (CA125) is a tumor-marker frequently associated with ovarian malignancies; however, benign gynecologic conditions (e.g. ovarian cysts) commonly cause a smaller increase in CA125 levels. This report describes an elderly Japanese woman with high CA125 levels and massive ascites caused by hypothyroidism. A 67-year-old woman presented herself with a weight gain of about 12 kg and abdominal distension. Her serum CA125 level was markedly elevated (822 U/ml) and abdominal CT revealed a right ovarian cyst and massive ascites. Hormonal laboratory data showed severe primary hypothyroidism with a serum TSH of 594 IU/L and a free thyroxin level of 0.05 ng/dl. Ascitic fluid was found to be exudate with a high protein content of 42 g/L. Cytological analysis and FDG-PET showed no evidence of malignancy. The ascites completely disappeared and serum CA125 normalized after adequate hormonal replacement therapy. These data suggest that hypothyroidism should be considered in patients with ascites and elevated serum CA125.

Hypermagnesemia induced by massive cathartic ingestion in an elderly woman without pre-existing renal dysfunction.

A 76-year-old woman was referred to our hospital for unresponsiveness and hypotension. She had developed constipation that had led to ileus and had received 34 g of magnesium citrate (Magcolol P) orally the day before. She was lethargic, her blood pressure was less than 50 mmHg, and electrocardiogram (ECG) revealed sinus arrest with junctional escape rhythm. Her serum concentration of magnesium (Mg) was markedly elevated (16.6 mg/dl =13.7 mEq/l). Emergency colonoscopy revealed ischemic colitis. As her condition ameliorated, her renal function returned to normal. Hence, the present case suggests that severe hypermagnesemia can occur in the absence of pre-existing renal dysfunction in elderly patients with gastrointestinal diseases.

Acute reversible myocardial depression associated with sepsis.

A 30-year-old man was admitted to our hospital for left lobar pneumonia with septic shock. Acute left-sided heart failure became evident as sepsis developed. Echocardiography revealed diffuse severe hypokinesis of the left ventricle (LV) and a pulmonary artery catheter showed Forrester subset II hemodynamics. Along with amelioration of sepsis and decrease of the serum concentrations of tumor necrosis factor-alpha and interleukin-6, LV hypokinesis improved. It is suggested that the patient's heart failure may have been due to functional depression of myocardial contractility resulting from a direct effect of the cytokines towards the cardiomyocytes, the so-called "septic myocardial depression".