Pediatric Case Challenge: Alarming Symptoms in a Toddler Who Had Myocarditis and Recently Immigrated

Shah Azmoon, MD; Matthew Budoff, MD; David Atkinson, MD


January 17, 2023

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An 18-month-old girl is brought to a pediatrician by her parents with a history of intermittent episodes of nighttime diaphoresis and agitation. The patient's medical history is significant for viral cardiomyopathy that was diagnosed when the child was aged 9 months. At that time, the patient had been taken to a local emergency department (ED) in her native country of the Philippines for chronic cough and worsening shortness of breath. Routine chest radiography was performed, which showed the presence of cardiomegaly; a two-dimensional echocardiogram further revealed dilated cardiomyopathy, with a left ventricular ejection fraction of approximately 20% and a left ventricular thrombus. The patient was diagnosed with cardiomyopathy presumed to be secondary to viral myocarditis, and her family was informed that the infant would need to be on long-term digoxin and captopril.

The following year, the patient and her family immigrated to the United States. As a result of financial constraints, the patient's family has not received any medication nor have they been able to seek medical care for the child in several months. No family history of significant disease, maternal radiation exposure, or intake of teratogenic drugs is noted.


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