Takotsubo cardiomyopathy associated with sepsis due to Streptococcus pneumoniae pneumonia

A 65-year-old woman was transferred from another hospital with a diagnosis of acute myocardial infarction associated with shock. An initial electrocardiogram (ECG) showed ST-segment elevation in leads V1-V6. A transoesophageal echocardiogram showed akinesis of the distal anterior septum and apical regions and hyperkinesis of the basal segments, with an ejection fraction of 20%- 25%. The coronary angiogram showed trivial coronary disease. By Day 6 of admission, the ECG showed normal left ventricle size and systolic function, with an ejection fraction of 65% and no regional abnormalities of wall motion. Sputum examination subsequently revealed typical Streptococcus pneumoniae. Our case demonstrates for the first time an association between sepsis and takotsubo cardiomyopathy. We analyse the possible role of sepsis and the systemic inflammatory response syndrome caused by severe infection as the initial causative mechanism of this syndrome.