Fulminant Myocarditis Mimicking Myocardial Infarction in a Young Woman: A Challenging Diagnosis and Treatment

Abstract

BACKGROUND: Fulminant myocarditis is a rare and serious condition with high mortality. It poses diagnostic challenges due to myocardial infarction-like symptoms and rapid deterioration. Timely diagnosis and access to advanced interventions are vital for optimal management and improved outcomes. CASE PRESENTATION: A 34-year-old woman presented with typical chest pain, ST changes, positive cardiac biomarkers, and impaired left ventricle function. The presumptive diagnosis was fulminant myocarditis complicated with cardiogenic shock, respiratory failure, and acute kidney injury. Leukocytosis and high anti-streptolysin O (ASO) titer suggested a recent streptococcal infection as a possible cause. Advanced intervention limitations hindered patient management. On the second day, the patient had a cardiac arrest. CONCLUSION: The diagnosis can be challenging due to the similarity of symptoms and signs to myocardial infarction, combined with the rapid deterioration of the patient’s condition. Prompt initiation of mechanical circulatory support is vital. However, its limited availability in developing countries hinders routine implementation, leading to unfavorable outcomes when life support measures are unavailable.