Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2021; 9(12): 2899-2907
Published online Apr 26, 2021. doi: 10.12998/wjcc.v9.i12.2899
Torsades de pointes episode in a woman with high-grade fever and inflammatory activation: A case report
Hui Qiu, Hong-Wei Li, Shu-Hong Zhang, Xiao-Ge Zhou, Wei-Ping Li
Hui Qiu, Hong-Wei Li, Wei-Ping Li, Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Shu-Hong Zhang, Xiao-Ge Zhou, Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Li WP and Qiu H conceived and designed the study; Qiu H was involved in data collection and analysis and drafting the article; Li HW participated in performance of the research; Zhang SH and Zhou XG performed the pathologic analyses and interpretation; Li WP revised the paper and had primary responsibility for final content; all authors issued final approval for the version to be submitted.
Supported by the Beijing Key Clinical Subject Program and Beijing Municipal Administration of Hospitals Incubating Program, No. PX2018002.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Ping Li, MD, PhD, Chief Doctor, Professor, Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. xueer09@163.com
Received: January 1, 2021
Peer-review started: January 1, 2021
First decision: January 24, 2021
Revised: February 7, 2021
Accepted: February 24, 2021
Article in press: February 24, 2021
Published online: April 26, 2021
Processing time: 103 Days and 18.9 Hours
Abstract
BACKGROUND

QT interval prolongation can induce torsades de pointes (TdP), a potentially fatal ventricular arrhythmia. Recently, an increasing number of non-cardiac drugs have been found to cause QT prolongation and/or TdP onset. Moreover, recent findings have demonstrated the key roles of systemic inflammatory activation and fever in promoting long-QT syndrome (LQTS) and TdP development.

CASE SUMMARY

A 30-year-old woman was admitted with a moderate to high-grade episodic fever for two weeks. The patient was administered with multiple antibiotics after hospitalization but still had repeating fever and markedly elevated C-reactive protein. Once after a high fever, the patient suddenly lost consciousness, and electrocardiogram (ECG) showed transient TdP onset after frequent premature ventricular contraction. The patient recovered sinus rhythm and consciousness spontaneously, and post-TdP ECG revealed a prolonged QTc interval of 560 ms. The patient’s clinical manifestations and unresponsiveness to the antibiotics led to the final diagnosis of adult-onset Still’s disease (AOSD). There was no evidence of cardiac involvement. After the AOSD diagnosis, discontinuation of antibiotics and immediate initiation of intravenous dexamethasone administration resulted in the normal temperature and QTc interval. The genetic analysis identified that the patient and her father had heterozygous mutations in KCNH2 (c.1370C>T) and AKAP9 (c.7725A>C). During the 2-year follow-up period, the patient had no recurrence of any arrhythmia and maintained normal QTc interval.

CONCLUSION

This case study highlights the risk of systemic inflammatory activation and antibiotic-induced TdP/LQTS onset. Genetic analysis should be considered to identify individuals at high risk of developing TdP.

Keywords: Torsades de pointes; Long QT syndrome; Adult-onset Still’s disease; Antibiotics; Inflammation; Case report

Core Tip: Torsades de pointes (TdP) is a life-threatening arrhythmia and may be caused by congenital long QT syndrome (cLQTS) or acquired LQTS (aLQTS). Meanwhile, aLQTS may share a similar genetic background with cLQTS. Here, we present a case of TdP episode during the combination of antibiotics for high-grade fever of unexplained origin before a confirmed diagnosis of adult-onset Still’s disease (AOSD). This case study highlights the importance of early diagnosis of AOSD, the key role of systemic inflammatory activation, and the risk of antibiotic-induced TdP/LQTS onset. Genetic analysis should be considered to identify individuals at high risk of developing TdP.