A case of fulminant myocarditis complicated by hemophagocytic syndrome

Abstract

Background: Fulminant Myocarditis and Hemophagocytic Syndrome (HPS) are independent life-threatening diseases. HPS, however, is a rare complication of fulminant myocarditis. It is hard to diagnose HPS in patients with fulminant myocarditis early, but timely identification affects the clinical result. Here is the report of a female who has developed HPS complications after fulminant myocarditis.

Case presentation: A 15-year-old Chinese female was admitted to the emergency department with a 3-day history of progressively severe chest pain and then a 1-day history of worsening heart failure needing the veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Interventions: V-A ECMO requiring continuous renal replacement therapy (CRRT) supported critically ill patients with heart failure. The vasoactive drug was used to improve cardiac function, maintain water, electrolyte, and acid-base balance, and nutritional supplements. High-dose methylprednisolone was administered for three days. Etoposide was given two times according to the treatment guideline, followed by cyclosporine. Diagnosis: The definitive diagnosis of the presented case was fulminant myocarditis complicated by hemophagocytic lymphohistiocytosis.

Conclusions: For fulminant myocarditis patients suspected of HPS, the functional examination must be considered for early diagnosis. The timely administration of adequate corticosteroids and standard chemotherapy is essential to reduce the risk of HPS mortality.