Coxsackie Myocarditis with Severe Methicillin-resistant Staphylococcus aureus Sepsis, Multi-organ Dysfunction Syndrome, and Posterior Epidural Spinal Abscess: A Case Report

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Rishabh Agarwal
2. Dnyanesh N Morkar
3. Rekha S Patil
ISSN
0972-5229
DOI
10.5005/jp-journals-10071-23333
Volume
24
Issue
1
Publishing Year
2020
Pages
3
Author Affiliations
1. com.mps.common.model.Contributor@4021ca05 ,
2. com.mps.common.model.Contributor@77adbe9c ,
3. com.mps.common.model.Contributor@4528bb05
Article keywords
Coxsackie, Methicillin-resistant Staphylococcus aureus, Myocarditis, Sepsis

Abstract

Aim: The aim of this paper is to present an interesting case of viral myocarditis complicated by sepsis, its sequelae, including multi-organ dysfunction syndrome, and the approach to manage it successfully. Background: Viral myocarditis is an inflammatory disease of myocardium, often leading to residual heart disease. Commonly, dengue and Coxsackie B viruses are the causative agents. Patients usually present with dyspnea, fever, and signs of heart failure. A possibility of bacterial sepsis should not be overlooked, given similar presentations may occur. Case description: A 21-year-old male presented with acute onset breathlessness, fever, chills, and severe neck pain. On a detailed workup, he was found to have features suggestive of viral myocarditis, bacterial sepsis, with bilateral pleural loculations, a posterior epidural spinal abscess. Elimination of infectious foci, along with a decision to stick to the ongoing antibiotics, instead of stepping up to the last available ones proved beneficial. Meticulous balance of diuretics and inotropes saved the patient\'s life from what turned out to be coxsackie myocarditis. Conclusion: Here, we present the case of a young male who came in with congestive heart failure due to Coxsackie myocarditis and his condition complicated by severe sepsis. Clinical significance: Up to 10% of the cases of coxsackie myocarditis progress to chronic dilated cardiomyopathy. The management is usually conservative, and antiviral agents have shown no role in speedy recovery. Elimination of infectious foci aggressively is of prime importance in the treatment of bacterial sepsis. A careful balance of inotropes, diuretics, and fluid management is needed to get the patient into remission in such cases.

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