RESUMO
A 47-year-old male was referred for rapid palpitations and an electrocardiogram compatible with sustained monomorphic ventricular tachycardia (VT) that required synchronized electrical cardioversion due to hemodynamic instability. After the initial clinical certainty, an etiological search is carried out. The transthoracic echocardiogram (TTE) revealed moderate dilatation and left ventricular systolic dysfunction due to global hypokinesia. Coronary angiography did not show significant coronary stenosis. Cardiac magnetic resonance (CMR) guarantees a nonischemic dilated cardiomyopathy with moderate systolic dysfunction and a pattern of subepicardial and intramyocardial late gadolinium enhancement (LGE) in medial-lateral and median inferolateral segments. Lastly, a positron emission tomography-computed tomography (PET-CT) scan showed diffuse fixation of the radiotracer in the left ventricular (LV) walls, with greater uptake on the lateral and inferolateral surfaces of inflammatory origin. After ruling out other alternative pathologies and according to current diagnostic criteria, the clinical judgment of probable isolated cardiac sarcoidosis (ICS) is established. An implantable cardioverter-defibrillator was implanted as secondary prevention of the acute arrhythmic event. Specific treatment for systolic dysfunction was prescribed, as well as immunosuppressive therapy with corticosteroids and methotrexate, after which the patient remained in clinical remission, with disappearance of active inflammation on cardiac imaging tests and progressive ventricular systolic function. The initial diagnosis of isolated cardiac sarcoidosis can be complex and challenging, especially in those patients in whom the diagnosis of extracardiac sarcoidosis has not been previously established. The limitations of endomyocardial biopsy in this entity make it necessary to have a high index of clinical suspicion with the early use of new cardiac imaging techniques and to include this picture in the differential diagnosis of patients with sustained ventricular arrhythmias or left ventricular systolic dysfunction of nonspecific etiology clarified. Early initiation of aggressive immunosuppressive therapy has been shown to prevent disease progression and limit its potential cardiac complications.
RESUMO
Introduction: The SARS-Cov-2 infection causing the COVID 19 disease mainly affects the respiratory system, in most cases presenting mild symptoms, however in patients with comorbidities such as pectus excavatum that cause an alteration in lung function, the disease It can be deadly. Case presentation: A 25-year-old male with a history of congenital pectus excavatum and scoliosis, with clinical of COVID 19 and confirmatory results of PCR, TC and Rx of the infection, begins with mild symptoms of affection in the upper respiratory tract, cough and odynophagia, that due to its basic anatomical alteration, progresses to SDRA, is treated with Oxygen Therapy, Ampicillin Sulbactam, Azithromycin, Oseltamivir, Lopinavir / Ritonavir, Hydroxychloroquine, Tiotropium, Paracetamol, Heparin and Omeprazole presenting a favorable evolution on the third day of hospitalization. Conclusion: The case reflects what is known to date about the risk of severe complications that SARS-CoV-2 infection can present in patients with comorbidities or pathologies that alter lung function such as the pectus excavatum. Therefore it would be important to generate specific management protocols for the clinical improvement of these patients with congenital anatomical alterations.
Introducción: La infección por SARS-CoV-2 causante de la enfermedad COVID 19 afecta principalmente el sistema respiratorio, en la mayoría de casos presenta síntomas leves, sin embargo en pacientes con comorbilidades como el pectus excavatum que originan una alteración en la función pulmonar la enfermedad puede ser mortal. Presentación de Caso: Masculino de 25 años de edad con antecedente de pectus excavatum congénito y escoliosis, con cuadro clínico de COVID 19 y resultados de PCR, TAC y Rx confirmatorios de la infección, inicia con sintomatología leve de afección en vías respiratorias superiores tos y odinofagia, que debido a su alteración anatómica de base, progresa a Síndrome de Distres Respiratorio Agudo, es tratado con Oxigenoterapia, Ampicilina Sulbactam, Azitromicina, Oseltamivir, Lopinavir/Ritonavir, Hidroxicloroquina, Tiotropio, Paracetamol, Heparina y Omeprazol presentando una evolución favorable al tercer día de hospitalización. Conclusiones: El caso refleja lo conocido hasta hoy sobre el riesgo de complicaciones severas que puede presentar la infección por SARS-CoV-2 en pacientes con comorbilidades o patologías que alteren la función pulmonar como el pectus excavatum. Por ello sería importante realizar protocolos de manejo específicos, útiles para la mejoría clínica de estos pacientes con alteraciones anatómicas congénitas.
