Журнал клинических случаев

Successful Treatment of Fulminant Myocarditis

Abstract

Calvin E Tucker, Margaret J Fernandez and Christopher C Morrison

Purpose: Myocarditis is an inflammatory process of the myocardium that can have an assortment of different etiologies such as infection, systemic disease and/or exposure to medications and toxins. There can be a variety of clinical presentations ranging from mild dyspnea and chest pain that can be self-limiting to cardiogenic shock and death. Although myocarditis can have several causes, viral infection remains the leading cause of both acute and chronic myocarditis. Corticosteroids, Intravenous Immunoglobulin (IVIG) and ventricular assist devices are controversial treatment options with minimal evidence of efficacy in the adult population. Summary: A critically ill patient presented to a large academic healthcare facility with flu-like symptoms and severe left ventricular dysfunction. The patient was given broad spectrum antimicrobials, corticosteroids and intravenous immunoglobulin as part of their treatment regimen. Due to severe left ventricular dysfunction, the patient required the use of a left ventricular assist device and extracorporeal membrane oxygenation for cardiac and hemodynamic support. After improvement in left ventricular function, the patient experience neuropathies requiring physical therapy and rehabilitation. Conclusion: This case report presents a patient with severe left ventricular dysfunction due to myocarditis. After administration of broad antimicrobial coverage, corticosteroids and IVIG, our patient experienced recovery of left ventricular function and overall improvement in his condition.