@article{oai:nagoya.repo.nii.ac.jp:00030428, author = {Hiraiwa, Hiroaki and Furusawa, Kenji and Kazama, Shingo and Kimura, Yuki and Shibata, Naoki and Arao, Yoshihito and Oishi, Hideo and Kato, Hiroo and Kuwayama, Tasuku and Yamaguchi, Shogo and Kondo, Toru and Sawamura, Akinori and Morimoto, Ryota and Okumura, Takahiro and Murohara, Toyoaki}, issue = {3}, journal = {Nagoya Journal of Medical Science}, month = {Aug}, note = {A 46-year-old Japanese woman visited a nearby hospital because of diplopia after flu-like symptoms. One month later, she presented with blepharoptosis and external ophthalmoplegia. Laboratory tests showed a high creatine kinase concentration (3146 U/L). She underwent intravenous immunoglobulin therapy; however, her symptoms did not improve, prompting transfer to our institute. On admission, transthoracic echocardiography revealed 30% of left ventricular ejection fraction and edema of the left ventricular wall. Coronary angiography showed no significant coronary stenosis. An endomyocardial biopsy resulted in a diagnosis of acute myocarditis. On the following day, she needed a temporary pacemaker because she had complete atrioventricular block and intra-aortic balloon pump because of cardiogenic shock. Intravenous immunoglobulin therapy was again administered and her cardiac function gradually recovered. She was successfully weaned off her temporary pacemaker and intra-aortic balloon pump on Day 5 after improvement in her complete atrioventricular block. Steroid therapy administered from Day 9 was effective in reducing her creatine kinase concentrations. However, contrast-enhanced magnetic resonance imaging revealed inflammation of the scalene, semispinalis cervicis, sternocleidomastoid, and intercostal muscles. On Day 25, her cardiac function had recovered to a left ventricular ejection fraction of 59%. Finally, she was successfully discharged on Day 45 after undergoing rehabilitation.}, pages = {585--593}, title = {Fulminant myocarditis with myositis of ocular and respiratory muscles}, volume = {82}, year = {2020} }