[Fulminant myocarditis].

Area of Science:

• Cardiology
• Infectious Diseases
• Immunology

Background:

• Fulminant myocarditis is a severe form of heart muscle inflammation.
• Ophthalmoplegia and cardiogenic shock indicate significant systemic involvement.
• Viral infections are common triggers for myocarditis.

Observation:

• A 46-year-old woman presented with ophthalmoplegia, followed by fulminant myocarditis and cardiogenic shock.
• Endomyocardial biopsy revealed inflammatory infiltrate, vasculitis, and positive PCR for multiple viruses (cytomegalovirus, Epstein-Barr virus, parvovirus B19, enterovirus).
• Recurrent myocarditis and left ventricular dysfunction were observed upon corticosteroid withdrawal, responding to re-initiation of therapy.

Findings:

• The patient experienced multiple episodes of fulminant myocarditis, severe left ventricular dysfunction, and ventricular tachycardia.
• Despite initial improvement with corticosteroids, the condition recurred, complicated by cutaneous purpura, suggesting vasculitis.
• The patient ultimately succumbed to pneumonia and ventricular dysfunction despite treatment with cyclophosphamide.

Implications:

• This case underscores the challenging and often recurrent nature of fulminant myocarditis.
• The potential role of concurrent viral infections and vasculitis in severe myocarditis requires further investigation.
• Management strategies for recurrent myocarditis, especially when associated with vasculitis, remain complex and may require multi-faceted therapeutic approaches.