Abstract
A 26-year-old woman was referred to an Emergency Department because of common flu-like syndrome with hemodynamic collapse. In Intensive Care Unit (ICU), she was diagnosed as a probable septic shock. But despite treatment her condition rapidly deteriorated during the subsequent hours. Diagnosis of cardiogenic shock was established. Mechanical circulatory support was inserted into the patient. She was transferred in a Cardio-Vascular Surgical ICU where at the 5th day of mechanical circulatory support, echocardiography showed heart recovery which allowed weaning of mechanical circulatory support and progressive withdrawal of inotropic support. She was discharged at the 26th day. During her hospitalization, presence of Influenza A RNA was shown in myocardial biopsy.
Highlights
Fulminant myocarditis causing severe hemodynamic dysfunction and requiring high-dose vasopressors or mechanical circulatory support is rare; intensive care unit physicians should be aware that its treatment may require the use of mobile circulatory support devices
We report a case of acute fulminant myocarditis caused by influenza A infection, a rare etiology, successfully treated by percutaneous extracorporeal membrane oxygenation (ECMO) with cardio-pulmonary bypass
Diagnosis of cardiogenic shock was established by the association of severe hemodynamic compromise requiring high-dose of vasopressor, low right atrial oxygen saturation (45%) and transthoracic echocardiography showing a diffuse hypokinesia with an estimated left ventricular ejection fraction (LVEF) of 20%, elevated right and left filling pressures
Summary
Fulminant myocarditis causing severe hemodynamic dysfunction and requiring high-dose vasopressors or mechanical circulatory support is rare; intensive care unit physicians should be aware that its treatment may require the use of mobile circulatory support devices. Degradation of the oxygenation (PaO2/FiO2 < 120) requiring mechanical ventilation was observed Her hemodynamic status rapidly deteriorated during the subsequent hours despite high doses of vasopressor (norepinephrine 5 mg/h). Hemodynamic data MAP (mmHg) Cardiac index (L × min-1 × m-2) LVEF (%) Urinary output (mL/h) Inotropic support Epinephrine (mg/h) Norepinephrine (mg/h) Dobutamine (μg × kg-1 × min-1) Biology Troponin I (ng/mL) BNP (pg/mL)) pH Lactate level (mmol/L) PaO2/FiO2 ASAT (IU/L)/ALAT (IU/L) Total bilirubin (mg/dL) INR Factor V (%). ICU: intensive care unit; CVVHDF: continuous veno-venous hemodiafiltration; ECMO: extracorporeal membrane oxygenation; MAP: mean arterial pressure; LVEF: left ventricle ejection fraction; BNP: brain natriuretic peptide; ASAT: aspartate aminotransferase; ALAT: alanine aminotransferase; INR International Normalized Ratio. On the 5th day of mechanical circulatory support, echocardiography showed improved diastolic and systolic function (LVEF of 50%) which allowed the progressive withdrawal of inotropic support. She was discharged on the 26th day with an LVEF of 70%, good diastolic function and no ventricular dilatation
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