Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 35(4): 284-289 (2019)

症例報告Case Report

新生児期にエンテロウイルスによる急性心筋炎を発症した1例Neonatal Enterovirus Myocarditis: A Case Report

1東京大学医学部附属病院小児科Department of Pediatrics, The University of Tokyo ◇ Tokyo, Japan

2東京大学大学院医学系研究科発達医科学Department of Developmental Medical Sciences, Graduate School of Medicine, The University of Tokyo ◇ Tokyo, Japan

3国立感染研究所National Institute of Infectious Diseases ◇ Tokyo, Japan

受付日:2018年12月29日Received: December 29, 2018
受理日:2019年6月5日Accepted: June 5, 2019
発行日:2019年11月1日Published: November 1, 2019

新生児心筋炎は致死率が50%以上と高く,エンテロウイルスは代表的な原因ウイルスとして知られている.今回我々はエンテロウイルスによる新生児期の急性心筋炎の症例を経験したので報告する.患者は40週1日,2,637 gで出生した.日齢2に発熱が出現し,日齢7に過剰心音を認め,心エコー検査では左室駆出率の低下を認めトロポニンTも陽性であったことから急性心筋炎の診断でカテコラミンによる治療が開始となった.日齢9に人工呼吸器管理が開始となった.経時的に呼吸状態・循環動態の改善認め日齢30に前医へ転院となった.日齢10の血液検体からエンテロウイルスが検出され原因ウイルスと考えられた.本症例においては移行抗体を認めず重症化に寄与した可能性が考えられた.心筋炎に対しては支持療法で治療の選択肢が限られていることから感染の予防に努めることが必要である.

Neonatal myocarditis is most often caused by enterovirus and has a high mortality of >50%. We report a case of neonatal enterovirus myocarditis. The patient was born at term with a birth weight of 2,637 g. He developed fever on perinatal day 2, and a gallop rhythm was detected by auscultation on day 7. Based on severe left ventricular dysfunction and elevated troponin T, the diagnosis of acute myocarditis was made. Despite inotropic support, his cardiovascular condition deteriorated. He was transferred to a tertiary medical center on day 9 and was further treated with inotropes and mechanical ventilation. On day 30, he was weaned from hemodynamic support and transferred back to the local hospital. Enterovirus was detected in the blood sample taken on day 10 and was thought to be the cause of myocarditis. The test result for neutralizing antibody was negative. Prevention of viral infection during the perinatal period is crucial, given the severity of the disease, requirement of intensive care, and limited treatment options currently available.

Key words: enterovirus; coxsackievirus B; neonatal myocarditis; transplacental antibody; cytokines

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