Acute Fulminant Myocarditis Secondary to Coxsackie B Virus

Fulminant myocarditis is a severe form of acute myocarditis, characterized by complications such as hemodynamic compromise, often requiring advanced mechanical support. It can occur as a result of infection, toxin exposure, or autoimmune processes. This is a case of a 53-year-old male with no past medical history who presented with one week of fever, shortness of breath, and upper respiratory symptoms and subsequently developed fulminant myocarditis, characterized by severe left ventricular dysfunction and cardiogenic shock requiring both inotropic and advanced mechanical support. Initial serological diagnostics were negative for a viral etiology; however, repeat testing, prompted by continued high clinical suspicion, subsequently yielded a positive Coxsackie B viral titer. The diagnosis of myocarditis was further supported by the specific distribution of late gadolinium enhancement (LGE) on cardiac MRI. We describe the nuanced management approach, including heart failure guideline-directed medical therapy (GDMT), high-dose steroids, and intravenous immunoglobulins. Additionally, we highlight the role of noninvasive diagnostics and the challenges in targeted management of fulminant myocarditis.