PDF(Pubmed)
Abstract：
BACKGROUND: The treatment of choice for Extra-osseous Ewing\'s sarcoma/primitive neuroectodermal tumor (ES/PNET), a rare neoplasm, is the VAC/IE regimen. This regimen includes Doxorubicin, Vincristine, Cyclophosphamide, Ifosfamide, and Etoposide, all of which have cardiotoxic effects. Myocarditis, a potentially threatening side effect following cancer therapy, can be accurately managed and diagnosed.
METHODS: In the current study, we report the case of a 19-year-old female with a mass on the abdominal wall, diagnosed with ES/PNET. She was treated with the VAC/IE regimen. A month after the last session of chemotherapy, she experienced dyspnea. Upon evaluation, a high level of troponin and a low left ventricular ejection fraction (LVEF) were detected via transthoracic echocardiography. She was treated with anti-heart failure drugs, but the response was unsatisfactory. The possibility of Cancer therapy-related myocarditis was suspected, and cardiac magnetic resonance imaging (CMR) confirmed acute myocarditis. This patient exhibited a significant response to intravenous immunoglobulin (IVIG), with her LVEF improving from 30-35% to 50% within three months.
CONCLUSIONS: In this case, based on negative tests and the absence of viral signs and symptoms, Cancer therapy-related myocarditis is highly suspected as the cause of myocarditis. This case underscores the importance of accurately utilizing CMR as a non-invasive method for diagnosing myocarditis. It effectively highlights the identification of reversible myocarditis with appropriate treatment and the notable response to IVIG, suggesting its potential as a favorable treatment for myocarditis in younger patients.
METHODS: In the current study, we report the case of a 19-year-old female with a mass on the abdominal wall, diagnosed with ES/PNET. She was treated with the VAC/IE regimen. A month after the last session of chemotherapy, she experienced dyspnea. Upon evaluation, a high level of troponin and a low left ventricular ejection fraction (LVEF) were detected via transthoracic echocardiography. She was treated with anti-heart failure drugs, but the response was unsatisfactory. The possibility of Cancer therapy-related myocarditis was suspected, and cardiac magnetic resonance imaging (CMR) confirmed acute myocarditis. This patient exhibited a significant response to intravenous immunoglobulin (IVIG), with her LVEF improving from 30-35% to 50% within three months.
CONCLUSIONS: In this case, based on negative tests and the absence of viral signs and symptoms, Cancer therapy-related myocarditis is highly suspected as the cause of myocarditis. This case underscores the importance of accurately utilizing CMR as a non-invasive method for diagnosing myocarditis. It effectively highlights the identification of reversible myocarditis with appropriate treatment and the notable response to IVIG, suggesting its potential as a favorable treatment for myocarditis in younger patients.
摘要：
背景：骨外尤文氏肉瘤/原始神经外胚层肿瘤（ES/PNET）的治疗选择，一种罕见的肿瘤,是VAC/IE方案。该方案包括阿霉素，长春新碱,环磷酰胺,异环磷酰胺,和依托泊苷,所有这些都有心脏毒性作用。心肌炎,癌症治疗后的潜在威胁副作用，可以准确地管理和诊断。
方法：在目前的研究中，我们报道了一个19岁女性腹壁有肿块的病例，诊断为ES/PNET。她用VAC/IE方案治疗。最后一次化疗一个月后，她经历了呼吸困难。经评估，通过经胸超声心动图检测到高水平的肌钙蛋白和低的左心室射血分数(LVEF).她接受了抗心力衰竭药物治疗,但反应并不令人满意。怀疑癌症治疗相关心肌炎的可能性，心脏磁共振成像（CMR）证实了急性心肌炎。该患者对静脉注射免疫球蛋白（IVIG）表现出明显的反应，她的LVEF在三个月内从30-35%提高到50%。
结论：在这种情况下，基于阴性测试和没有病毒体征和症状，高度怀疑癌症治疗相关的心肌炎是心肌炎的原因。此病例强调了准确利用CMR作为诊断心肌炎的非侵入性方法的重要性。它有效地突出了通过适当治疗的可逆性心肌炎的识别和对IVIG的显着反应，提示其作为年轻患者心肌炎的有利治疗方法的潜力。
方法：在目前的研究中，我们报道了一个19岁女性腹壁有肿块的病例，诊断为ES/PNET。她用VAC/IE方案治疗。最后一次化疗一个月后，她经历了呼吸困难。经评估，通过经胸超声心动图检测到高水平的肌钙蛋白和低的左心室射血分数(LVEF).她接受了抗心力衰竭药物治疗,但反应并不令人满意。怀疑癌症治疗相关心肌炎的可能性，心脏磁共振成像（CMR）证实了急性心肌炎。该患者对静脉注射免疫球蛋白（IVIG）表现出明显的反应，她的LVEF在三个月内从30-35%提高到50%。
结论：在这种情况下，基于阴性测试和没有病毒体征和症状，高度怀疑癌症治疗相关的心肌炎是心肌炎的原因。此病例强调了准确利用CMR作为诊断心肌炎的非侵入性方法的重要性。它有效地突出了通过适当治疗的可逆性心肌炎的识别和对IVIG的显着反应，提示其作为年轻患者心肌炎的有利治疗方法的潜力。
