The 52nd meeting: "Missing Elements of the History"


Ciao, this is Hakodate Ryouhoku Hospital.
I'm Dr. Daisy.
A 59-year-old woman presented to her primary care physician with cough, exertional dyspnea, and foot swelling that had developed 2 weeks earlier while she was vacationing in Denmark.
In this case, several features support cobalt cardiomyopathy as the likely diagnosis.
Transmission electron microscopy showed cardiomyocyte hypertrophy with substantial loss of contractile elements, increased lipid levels, and other degenerative features that were consistent with dilated cardiomyopathy. In addition, enlarged and atypical mitochondrial forms were noted; these findings indicated possible direct mitochondrial injury.
Cobalt cardiac toxicity was first characterized in the early 1960s as “Quebec beer-drinkers' cardiomyopathy,” which was attributed to a cobalt-based foam-stabilizing agent. The clinical presentation during that epidemic was quite similar to the case presented here, with a rapidly progressive cardiomyopathy after the onset of symptoms in otherwise fairly young and healthy persons.
The patient had originally learned 13 months before transplantation that her bilateral DuPuy ASR metal-on-metal hip prostheses were recalled because of higher-than-expected failure rates.
This case suggests that a variety of clinical specialists in orthopedics, cardiology, cardiac surgery, endocrinology, rheumatology, ophthalmology, and pathology and their patients may benefit from improved awareness and multidisciplinary communication regarding the potential risks associated with these devices.
Thank you for listening, ciao.

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