Case history/examination
A 32-year-old male patient was admitted to our hospital for the purpose of examination and treatment of progressively deteriorating symptoms from two days chest pain and persisting chest tightness and breath shortness over a year lone.
Prior to this admission, the patient was firstly admitted to a local hospital for symptoms of chest tightness, shortness of breath and dyspnea following physical activity. His blood creatinine level was 126umol/L (reference range, 62 to 115 umol/L), the glomerular filtration rate was 65.11ml/min, the troponin T level was 37 pg /mL (reference range <17.5 pg /mL) and the N-terminal pro-brain natriuretic peptide (NT-proBNP) was 2264.0pg/mL (reference range, <125 pg /mL). The rest of the labs were normal. The patient was prescribed with aspirin, benazepril hydrochloride, spironolactone, atorvastatin, amiodarone, and metoprolol tartrate while admitted to the local hospital. After five days of treatment, the patient was discharged with relief from chest tightness. However, two days after discharge, he came back to another higher-graded hospital’s clinic in Chongqing for second visit with the same symptoms.
The electrocardiogram (ECG) (Figure. 1) conducted at the second hospital showed sinus rhythm with T-wave abnormalities. Additionally, transthoracic echocardiography revealed an enlarged left heart with a septal thickness of 12 mm (normal range, 8 to 11), generally reduced left ventricular wall motion, reduced left ventricular systolic function, reduced diastolic function, and an ejection fraction of 49% (normal range, 55 to 70), as well as mild mitral and tricuspid regurgitation. Prescription continued as previously administered. However, the symptoms constantly to be recurrent, this was the reason the patient was admitted to our hospital in the hope of further clarifying the diagnosis and treatment.
The patient’s medical history included hypertension and claims of normal blood pressure control, with no known history of diabetes mellitus. The skin on the neck was noted to be hardened from early 2021 without other noticeable redness, swelling, or pain. A skin pathology biopsy was carried out in July 2021 at a local hospital’s clinic because the skin sclerosis had expanded to the back and scleredema was diagnosed. He admitted a history of smoking for more than 20 years and denied any history of drinking.