AUTHOR=Li Huanhuan , Li Lun 

TITLE=Successful treatment of fulminant myocarditis with intra-aortic balloon pump counterpulsation combined with immunoglobulin and glucocorticoid in a young male adult

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.905189

DOI=10.3389/fcvm.2022.905189

ISSN=2297-055X

ABSTRACT=Abstract
Background: Fulminant myocarditis (FM) is a serious non-specific inflammatory disease of myocardium. FM tends to occur in adolescents, the course of disease progresses rapidly. It is prone to cardiogenic shock (CGS) and multiple organ failure (MOF), with high mortality. We report a case of FM with CGS and MOF in a young male who was successfully treated with intra aortic balloon counterpulsation pump (IABP) combined with intravenous immunoglobulin (IVIG) and glucocorticoid (GC).
Case summary: A 21-year-old previously healthy man presented fever, headache and chest tightness. He came to the hospital for emergency treatment. The laboratory data showed that the levels of serum cardiac troponin I (cTnI), N-terminal B-type natriuretic peptide precursor (NT-proBNP), myocardial zymogram and neutrophils increased. Echocardiography showed pericardial effusion and decreased left ventricular systolic function. Electrocardiogram (ECG) showed diffuse ST segment elevation. He was clinically diagnosed with FM and admitted to the intensive care unit for treatment. Within 48 hours of admission, the clinical course of the patient deteriorated rapidly, with CGS accompanied by MOF, high atrioventricular block (A-V-B) and ventricular tachycardia (VT). After using mechanical circulatory support (MCS) therapy with IABP, IVIG , GC, continuous renal replacement therapy (CRRT), mechanical ventilation complicated with temporary cardiac pacemaker, he recovered normal cardiac function. He made a full recovery and was discharged home on day 21. 
Discussion: For FM patients, early diagnosis, close monitoring, timely use of MCS device and active comprehensive treatment are very important. MCS devices such as IABP can become life-saving tools for the treatment of FM.