Acute interstitial myocarditis in an infant

Hivtory.--H. T., a 1-year-old white girl, was admitted to the Jewish Hospital Pediatric Service on March 31, 1935, with the complaint of rapid breathing with grunting expiration, which had begun ten days previously and had become progressively worse. Her appetite failed, and she lost 5 pounds. For the previous two days she had been irritable and drowsy. Birth and developmental history were normal. The child had begun to walk two weeks bes the onset of this illness. There had been no previous illnesses of note. The child had played with toys, the paint on which which was found to contain lead. Fa~n~ly His~o~y.--Both maternal grandparents had arteriosclerotic heart disease. Physical Exa~nimation.--Examination showed a well-developed and nourished child, irritable, but alert. The temperature was 99 ~ (rectal) ; pulse, 160; respirations, 60. There was a mucoid nasal discharge. Breathing was almost entirely diaphragmatic, with grunting expiration. The percussion note was resonant, and the breath sounds were normal. No rMes were heard. The heart was not enlarged. The sounds were of good quality. A systolic murmur was heard best over the mitral area and was transmitted into the left axilla. The murmur was less intense over the aortic area. The liver could be felt 1 cm. below the costal margin in the midclavicular line. The spleen was not palpable. The child assumed a gun-hammer position. The patellar reflexes were hyperactive. The biceps and abdominal reflexes were not elicited. Babinski 's, Kernig 's , and Brudzlnski 's signs were negative. Laboratory Data.--On admission acetone and a trace of albumen were present in the urine, but these disappeared during the hospital stay. Dr. Robert :Kehoe reported no increase of lead in the urine. Repeated counts showed a red blood count of about 3,500,000, with hemoglobin 60 to 65 per cent. The white blood counts varied between 14,000 on admission to 10,000 later on, with the differential count showing 47.5 per cent polymorphonuclears and 48 per cent lymphoeytes. There were moderate anisocytosis, slight poikiloeytosis~ and on one occasion ] per cent eosinophiles and 2.5 per cent reticulocytes. There was no stippling. Blond calcium was 11.2 per cent. The lead content of the stool, determined by Dr. Kehoe, was normal. Spinal fluid pressure was normal. Globulin in the spinal fluid was negative. There were four cells per cubic millimeter. Lead content was at the upper level of normal. Sugar was 86 mg. per cent. The Wassermann test was negative. The Schick test was negative. Tuberculin tests with P.P.D. No. 2 were negative. Cultures from nose and throat showed staphylococci. No ]~lebs-L~ffier organisms were found. The mother 's blood Wassermann test was negative. l~oentgen Exam~nations.--On April 1, 1935, the ulna and radius showed no lead line. On April 2, 1935, lung films were interpreted as follows: Both lungs showed diffuse parenchymatous infiltration along the bronchial tree, apparently due to a bronchitis. The heart was normal in position, size, a~d shape. Teleoroentgenograms of the chest on April 11, ]935, showed the same findings as above. On April 23, 1935, the heart was deviated to the right, and in addition to the previous findings, there was a triangular dense shadow at the base of the right lung, possibly produced by atelectasis of the right lower lobe.