Fulminant lymphocytic myocarditis secondary to Coxsackie A virus with full myocardial recovery following venoarterial extracorporeal membrane oxygenation

Future Cardiol. 2022 Dec;18(12):925-929. doi: 10.2217/fca-2022-0078. Epub 2022 Nov 22.

Abstract

We present a case of a 30-year-old female with no pertinent medical history who presented with 4 days of chest pressure, dyspnea and fever. She had hemodynamic compromise and had elevated cardiac and inflammatory markers consistent with cardiogenic shock. ECG demonstrated anterior ST-segment elevations with reciprocal changes. Coronary angiography revealed normal coronaries and echocardiogram showed severe biventricular dysfunction. Endomyocardial biopsy showed signs of lymphocytic myocarditis and viral testing was positive for Coxsackie A. She was initially supported with an intra-aortic balloon pump and later escalated to venoarterial extracorporeal membrane oxygenation due to electromechanical compromise. With supportive care, she was weaned off venoarterial extracorporeal membrane oxygenation and made a full myocardial recovery on follow up echocardiogram and cardiac MRI.

Keywords: cardiac catheterization; cardiogenic shock; echocardiography; fulminant myocarditis; intra-aortic balloon pump; ischemic heart disease; venoarterial extracorporeal membrane oxygenation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Extracorporeal Membrane Oxygenation*
  • Female
  • Heart-Assist Devices*
  • Humans
  • Intra-Aortic Balloon Pumping
  • Myocarditis* / diagnosis
  • Myocarditis* / etiology
  • Myocarditis* / therapy
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / therapy