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Case Reports
. 2024 Dec 1;63(23):3189-3195.
doi: 10.2169/internalmedicine.3442-23. Epub 2024 Apr 9.

Patient with Gender Dysphoria Diagnosed with Multiple Sclerosis Following Takotsubo Cardiomyopathy and Ventricular Arrhythmia: A Case Report and Systematic Literature Review

Shinya Yamanaka  1 , Mariko Nishihara  1 , Madoka Kondo  2 , Kotaro Miyata  3 , Zhehao Dai  3   4 , Fujimi Kawai  5 , Nobuyuki Komiyama  3
Affiliations
Case Reports

Patient with Gender Dysphoria Diagnosed with Multiple Sclerosis Following Takotsubo Cardiomyopathy and Ventricular Arrhythmia: A Case Report and Systematic Literature Review

Shinya Yamanaka et al. Intern Med. .

Abstract

A 34-year-old transgender woman presented with ventricular tachycardia and was diagnosed with takotsubo cardiomyopathy. Further evaluation revealed an underlying diagnosis of multiple sclerosis (MS) with brainstem lesions that may have triggered takotsubo cardiomyopathy. In this report, we also systematically reviewed published cases of takotsubo cardiomyopathy and MS and found that basal type takotsubo cardiomyopathy was the most common, and most patients presented with brainstem involvement of MS. An awareness of these associations by physicians, along with multidisciplinary collaboration, may facilitate the early diagnosis and improve the prognosis of these patients.

Keywords: multiple sclerosis; systematic literature review; takotsubo cardiomyopathy; ventricular arrythmia.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Twelve-lead electrocardiography. (A) Ventricular tachycardia was noted upon the visit to the emergency department. (B) Intravenous injection of magnesium sulfate restored sinus rhythm, with ST elevation in aVR, diffuse ST depression in other leads, and QT prolongation. (C) ST changes partially improved upon discharge.
Figure 2.
Figure 2.
Transthoracic echocardiography performed on day 2 showed a severely reduced left ventricular ejection fraction of 30% with basal segment severe hypokinesis (yellow arrows). (A) Diastole. (B) Systole. LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle
Figure 3.
Figure 3.
On fluid-attenuated inversion recovery magnetic resonance imaging, multiple sclerosis lesions were seen in the bilateral periventricular and subcortical white matter (A, B) and pontomedullary junction (yellow arrows) (C, D).
Figure 4.
Figure 4.
PRISMA flow diagram of the systematic literature review in this study.
See this image and copyright information in PMC

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