Myocarditis in a Patient with Diabetic Ketoacidosis: A Case Report

Manchester Royal Infirmary, England

*Corresponding author: Dr. Fatima Saeed, Manchester Royal Infirmary, England, Tel: 07375737352, Email: [email protected].

Received Date: May 20, 2023

Published Date: June 12, 2023

Citation: Saeed F, et al. (2023). Myocarditis in a Patient with Diabetic Ketoacidosis: A Case Report. Mathews J Anesth. 4(1):12.

Copyrights: Saeed F, et al. © (2023).

ABSTRACT

A case of diabetic ketoacidosis (DKA) complicated by acute myocarditis, which was confirmed by Cardiac MRI. A 27-year-old man with diagnosed type 1 diabetes mellitus was hospitalized with severe DKA, blood sugar on admission was 69.3mmol/l and Hba1c was 104 mmol/mol. The initial ECG showed no acute changes however later he developed ST-T changes on his ECG associated with a significant troponin rise which raised the possibility of Myocarditis. The coronary angiogram ruled out any coronary artery disease, however the diagnosis of Myopericarditis was confirmed based on the echocardiogram findings and cardiac MRI. Viruses are the most common causative agents of myocarditis, our patient described symptoms of fatigue that might indicate the probable underlying viral infection however the excessive alcohol intake and non-compliance with insulin were the contributing factors towards development of diabetic ketoacidosis. The whole viral screen including parvovirus and covid-19 was negative. The Epstein bar virus (EBV) although weekly positive, with minimal viral load couldn’t account for the patient’s symptoms. Another rare condition that can present with myocarditis is fulminant type 1 diabetes mellitus, which is believed to be non-immune condition causing rapid onset of diabetes mellitus, the exact aetiology is still uncertain, but the presence of islet injury accompanied by myocardial inflammation points towards underlying viral infection as the cause of sudden onset of diabetes mellitus. The auto antibodies for Type 1 DM turn out to be negative in these cases, however in our patient they weren’t done because he was a confirmed Type 1 Diabetic. The patient successfully responded to the symptomatic treatment for DKA, implicating that severe DKA was the cause of myocarditis. He was provided education on Type 1 diabetes mellitus and subsequently discharged without any further complications with future outpatient appointment in cardiology clinic.

Keywords: Myocarditis, Diabetic Ketoacidosis, Fulminant Type 1 Diabetes.