Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website https://www.journalmc.org

Case Report

Volume 13, Number 6, June 2022, pages 263-268

Takotsubo Cardiomyopathy Secondary to Cryptococcal Meningoencephalitis in a Patient With Multiple Sclerosis

Figures

Figure 1.
Figure 1. Electrocardiogram on presentation to the emergency department with seizure-like activity, headache, nausea, vomiting, diarrhea, and severe fatigue.
Figure 2.
Figure 2. Electrocardiogram following cardiopulmonary arrest and resusitation.
Figure 3.
Figure 3. Apical five-chamber view with apical ballooning of the LV (white arrows) seen with Takotsubo cardiomyopathy. LV: left ventricle.
Figure 4.
Figure 4. Subcostal view with contrast ultrasound enhancing agent demonstrating hypokinesis of the anterolateral, anteroseptal, and apical segments (yellow arrows) as well as basal segment hyperkinesis (green arrow).
Figure 5.
Figure 5. Illustration of the hypothesized brain-heart axis: cryptococcal meningoencephalitis leading to autonomic activation and a diffuse surge of catecholamines, negatively affecting the left ventricle. CNS: central nervous system.

Table

Table 1. Patient’s Lab Work on Admission
 
LabValueReference range
Hemoglobin11.4 g/dL11.1 - 15.9
Hematocrit32.7%34 - 46.6
White blood cell20.8 × 103/µL3.4 - 10.8
Platelets141 × 103/µL150 - 450
Sodium128 mEq/L134 - 144
Potassium2.5 mEq/L3.5 - 5.3
Chloride88 mEq/L98 - 109
Creatinine0.64 mg/dL0.57 - 1.00
Blood urea nitrogen12 mg/dL7 - 25
Calcium8.9 mg/dL8.7 - 10.3
Glucose200 mg/dL70 - 99
Lactic acid2.2 mmol/L0.5 - 2.2