Life-threatening Dysrhythmias in Varicella Myocarditis

Woolf, Paul K.; Chung, T.; Stewart, Julian M.; Lialios, Minas; Davidian, Marianna M.

doi:10.1177/000992288702600911

Cited by 15 publications

(8 citation statements)

References 11 publications

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“…15 reported the occurrence of CAVB after an uneventful complete recovery from a disseminated VZV infection. Intravenous administration of acyclovir did not affect the course of the disease in any of the reported cases 12,16,17 . Nurnberg et al.…”

Section: Details Of the Casementioning

confidence: 82%

“…VZV causing viral myocarditis has been previously reported in paediatric patients 12–17 . These patients presented with CAVB and some require permanent pacemaker insertion 12–14,17 . Nurnberg et al.…”

Section: Details Of the Casementioning

confidence: 99%

“…Despite the fact that the most common sequelae of viral myocarditis is chronic dilated cardiomyopathy, 11 several study series reported the evidence of VZV myocarditis presenting as CAVB. VZV causing viral myocarditis has been previously reported in paediatric patients 12–17 . These patients presented with CAVB and some require permanent pacemaker insertion 12–14,17 .…”

Section: Details Of the Casementioning

confidence: 99%

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Complete heart block in a patient with acute lymphoblastic leukaemia: teicoplanin as a possible cause and review of literature

Sharif‐Yakan

Arabi

Musharrafıeh

et al. 2012

Journal of Clinical Pharmacy and Therapeutics

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SUMMARYWhat is known and Objective: Teicoplanin is a glycopeptide antibiotic used against documented or presumed methicillin-resistant infections. We report a 31-month-old boy with acute lymphocytic leukaemia who developed permanent complete atrioventricular block (CAVB) necessitating pacemaker insertion after receiving teicoplanin for Staphylococcus epidermidis bacteremia. Case summary: Clinical assessment of the child revealed febrile neutropenia. After thorough assessment and work-up, the patient was started on teicoplanin intravenously after which he had sudden onset of bradycardia. Electrocardiography showed CAVB that eventually required permanent pacemaker insertion. Twenty-nine months from the incident, the patient is doing well. What is new and Conclusion: We report on a case of teicoplanin-associated CAVB in a child with acute lymphoblastic leukaemia (ALL). This is one of only two similar cases reported in the literature. Teicoplanin remains the most probable cause. The use of teicoplanin should be approached cautiously in the setting of immunosuppression. Whether VZV contributed and teicoplanin triggered remains speculative. Physicians should be aware of this possible complication. WHAT IS KNOWN AND OBJECTIVETeicoplanin is a glycopeptide antibiotic used against methicillinresistant gram-positive infections.1 It is generally well tolerated at therapeutic doses.2 Complete atrioventricular block (CAVB) induced by teicoplanin has been reported once in the literature. 3 We report another case of teicoplanin-induced CAVB in a child with acute lymphoblastic leukaemia (ALL). To the best of our knowledge, only one other similar case has been reported. DETAILS OF THE CASEA 31-month-old boy diagnosed at the age of 16 months with intermediate-risk T-cell ALL presented to the hospital for maintenance chemotherapy week #51 that consisted of 6-mercaptopurine (6-MP) at a dose of 60 mg/m 2 /day and methotrexate at 40 mg/ m 2 /week. Clinical assessment of the child on admission revealed febrile neutropenia which prevented the patient's receipt of the recommended chemotherapy. Fever work-up including blood cultures was performed, and the patient was discharged after receiving a single dose of ceftriaxone intravenously. Three days later, blood cultures showed coagulase-negative, gram-positive cocci identified as Staphylococcus epidermidis and the child was called for further management.On presentation, the patient was stable and in no acute distress. His vital signs were as follows: temperature of 36AE2°C, heart rate of 126 bpm, respiratory rate of 26 breaths per minute and blood pressure of 101/50 mmHg with 100% oxygen saturation. His electrocardiography (EKG) showed normal sinus rhythm. After re-evaluation of the patient and based on his previous studies and blood cultures, he was started on teicoplanin intravenously at a dose of 10 mg/kg twice daily. Fifteen hours later, there was sudden onset of bradycardia with the heart rate reaching 45 bpm. There was no obvious clinical distress, and cardiac examination revealed nor...

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Section: Details Of the Casementioning

confidence: 82%

Section: Details Of the Casementioning

confidence: 99%

Section: Details Of the Casementioning

confidence: 99%

See 1 more Smart Citation

Complete heart block in a patient with acute lymphoblastic leukaemia: teicoplanin as a possible cause and review of literature

Sharif‐Yakan

Arabi

Musharrafıeh

et al. 2012

Journal of Clinical Pharmacy and Therapeutics

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“…8 Our patient responded very well to standard management, which is consistent with available literature. 9 Staphylococcus aureus seems to be the most common organism to cause purulent pericarditis in varicella, 10 although Streptococcus and meningococcus have also been reported. With early diagnosis and aggressive therapy, purulent pericarditis in young patients has a good prognosis.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Tamponade and Pleural Effusion Complicating Varicella

Masood¹,

Kiel²,

Akingbola³

et al. 2008

Pediatric Emergency Care

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Varicella is a common infectious disease, usually benign and self-limited, and complications are believed to be rare. Most cases occur in healthy children younger than 14 years. Serious complications are uncommon, although high-risk groups have been identified, such as immunosuppressed patients, neonates, and adults. Cardiac tamponade after pericardial effusion occurring as a complication of varicella infection has been very infrequently reported. We describe an 8-month-old infant presenting with cardiac tamponade after varicella infection secondary to purulent bacterial pericardial effusion. He required a pericardial window formation. He also developed pleural empyema, another uncommon complication requiring thoracostomy drainage. This illustrative case, management, and unique features will be presented along with a review of all cases of varicella complicated by pericarditis in the English literature.

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“…Noren et al [5] found post-mortem evidence of myocarditis without pericardial involvement in 11 of 17 children who died with varicella infection, and there have been a number of cases described with non-fatal varicella infection and clinical evidence of myocardial and/or pericardial involvement [1,10,14]. Isolated pericarditis is less commonly described [8] and probably represents part of a spectrum ranging from subclinical ECG changes to severe myocardial involvement with congestive cardiac failure and subsequent death.…”

Section: Discussionmentioning

confidence: 99%