Post-Diphtheritic Myocarditis with Right Ventricular Thrombus: A Rare Cardiac Complication
Abstract
Background: Myocarditis is a serious consequence of diphtheria; however, the occurrence of a subsequent right ventricular (RV) thrombus is exceedingly rare. We provide an uncommon case of post-diphtheritic myocarditis complicated by a right ventricular thrombus and secondary pneumonia, emphasizing its effective multi-modal therapy and subsequent recovery.
Case presentation: A 19-year-old female arrived at our emergency department with acute dyspnea and chest pain two weeks after a 3-day hospitalization for pharyngeal diphtheria at Galkacyo Regional Hospital. Laboratory analyses revealed increased Troponin I (2615 ng/L), CK (511 U/L), and severely high NT-proBNP (33,349.0 pg/mL). Chest radiography verified the presence of simultaneous right lower lobe pneumonia. Electrocardiography revealed low-voltage QRS complexes, whereas echocardiogram indicated worldwide hypokinesia (LVEF 40-45%) and a movable hypoechoic mass at the right ventricular apex, strongly suggesting the presence of a right ventricular thrombus.
Management and outcome: The patient was admitted to a designated ICU bed and commenced on broad-spectrum antibiotics, guideline-recommended heart failure pharmacotherapy (metoprolol, furosemide, empagliflozin), and therapeutic anticoagulation with subcutaneous enoxaparin. She was released on a two-month regimen of oral anticoagulation. Five-month serial follow-up demonstrated total clearance of the right ventricular thrombus, a fully normalized ejection fraction, and…
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