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We report a case of a 22 year old pregnant women seen after uterine curettage resulting from “missed abortion”. The patient's condition deteriorated because of dyspnoea and leg oedema. We observed raised C-reactive protein, leucocytosis, low platelet count, and signs of disseminated intravasal coagulation. Extensive microbiological analysis did not disclose any microorganisms.
Diagnostic criteria for SIRS (systemic inflammation response syndrome)—that is, fever, tachycardia, tachypnoea, and low arterial pco 2—were positive. We did not disclose any signs for pre-eclampsia, postpartum cardiomyopathy, antiphospholipid syndrome, or systemic lupus erythematosus.
Echocardiography showed a dilated left ventricle (end diastolic diameter 60 mm) with greatly reduced global systolic left ventricular function (ejection fraction 20%). As shown below (left), there were substantial amounts of mobile masses with cystic appearance located at the free wall of the right ventricle. Colour tissue Doppler echocardiography (below right) revealed an intraventricular mass moving in different directions in comparison to the adjacent myocardial walls. A ring-like cystic mass was also found in the left ventricle.
The patient was initially treated with broad spectrum antibiotics, digitalis, angiotensin converting enzyme inhibitors, diuretics, and low molecular weight heparin, followed by warfarin. The size of the right and left ventricular thrombus decreased in serial echocardiographs. Four months later thrombus formation was no longer detectable and the patient was in good condition; her ejection fraction had increased to 40% without any left ventricular enlargement.
In conclusion, we describe a case of sepsis-like syndrome after uterine curettage as a result of “missed abortion”, with consecutive severe dilated cardiomyopathy and mobile biventricular thrombi.