不明原因發熱作為心臟黏液瘤的始發癥狀

Fever of Unknown Origin as An Initial Symptom of Cardiac Myxoma

眾所周知，心臟黏液瘤的臨床表現是Godwin氏三聯症，即梗阻性、全身性及血栓性症狀。然而，心臟黏液瘤的臨床表現也可以是多樣性和非特異性的，這會貽誤診斷和治療，並最終導致意料之外的不良預後。不明原因發熱是心臟黏液瘤的一種罕見的臨床表現。一位56歲女性病患表現為持續性低熱，且抗生素治療效果差。她後來出現胸部不適和勞力性呼吸困難。她檢查了超音波，被診斷為左心房黏液瘤，而接受心臟黏液瘤摘除手術。手術後，她並發完全性心臟傳導阻滯，先用臨時心臟起搏器和靜脈用小劑量異丙腎上腺素，繼之以三分三浸膏片（克朗寧）和沙丁胺醇口服，於術後12天恢復竇性心律。表現為不明原因發熱的心臟黏液瘤的診斷具有挑戰性，治療可被貽誤。不明原因發熱的病患且對抗生素治療效果差者，應懷疑為心臟黏液瘤，且有進行超音波檢查之必要。

It is well-known that the clinical manifestations of cardiac myxoma are Godwin's triad, i.e., obstructive, constitutional and embolic symptoms. However, the clinical manifestations of cardiac myxoma can also be miscellaneous and uncharacteristic, which may lead to delayed diagnosis and treatment, and ultimately an unexpected poor prognosis. Fever of unknown origin is one of the rare manifestations of cardiac myxoma. A 56-year-old woman with a prolonged low-grade fever exhibited a poor response to antimicrobial therapies. Later, she developed chest discomfort and exertional dyspnea. She was examined by echocardiography, which revealed a left atrial myxoma. She underwent a wide excision of the atrial myxoma, after which she developed high-grade heart block with bradycardia, which required the use of a temporary pacemaker and low-dose intravenous isoprenaline, followed by oral scopoloa acutangula extract tablets and salbutamol. She recovered to normal sinus rhythm on postoperative day 12. The diagnosis of cardiac myxoma presenting with fever of unknown origin can be challenging and can delay the proper treatment. The presence of fever of unknown origin with a poor response to antibiotic treatments should raise a suspicion of cardiac myxoma and necessitate an echocardiographic examination.