Pneumonia and de novo atrial fibrillation in a patient with myotonic dystrophy type 1: A case report

Myotonic dystrophy type 1 is a rare genetic disorder that mainly affects the musculoskeletal system; However, it may cause several complications in other body systems representing challenges for health care providers. PATIENT CONCERNS: We present the case of a patient with a history of previously diagnosed type 1 myotonic dystrophy who presented to the emergency department with cough dyspnea, and thoracic pain. DIAGNOSIS: Differential diagnoses included pulmonary embolism with a moderate probability according to the Wells score, acute coronary syndrome, acute heart failure, and pneumonia. Diagnostic workup involved chest radiography, EKG, and a CTPA which revealed pneumonia, posteriorly the patient presented de novo atrial fibrillation. INTERVENTIONS: The patient was successfully treated with empiric antibiotic therapy and amiodarone, respiratory and physical therapy. OUTCOMES: The patient was discharged on day 34, however oxygen weaning was not possible. CONCLUSION: Treatment of MD1 patients is challenging due to the various mechanisms of the disease; patients with new-onset deterioration should be screened for the most common complications such as cardio-respiratory events. The authors suggest pneumonia as a risk factor for basal respiratory function deterioration and a contributing factor for triggering cardiac events for further research in prospective studies.