Dramatic Improvement of Acute Fulminant Lymphocytic Myocarditis with Short-course Intravenous Pulse Corticosteroids: A Case Study

Abstract

We report a 31-year-old patient with acute fulminant myocarditis, resulting in cardiogenic shock that necessitated mechanical circulatory support, who improved dramatically after treatment with intravenous (IV) pulse steroids. A coordinated multidisciplinary team was the key secret in the cure of this critical patient. In this case study, we focus on the role of IV pulse steroids in the treatment of fulminant lymphocytic myocarditis.

Keywords: Fulminant myocarditis; immunomodulatory therapy; intravenous pulse corticosteroids.

Figure 1

Electrocardiography at presentation showing sinus tachycardia with ST-segment elevation in leads III, aVF, and in leads V1-V3 with ST-segment depression in leads I and aVL

Figure 2

Electrocardiography at discharge showing normal sinus rhythm with no other significant changes

Figure 3

Chest X-ray at presentation, anteroposterior view showing huge cardiomegaly, and pulmonary congestion

Figure 4

Chest X-ray at discharge, anteroposterior view showing mild cardiomegaly, and resolved pulmonary congestion

Figure 5

M-mode transthoracic echocardiogram at presentation showing severe left ventricular dysfunction with an ejection fraction of 20%

Figure 6

M-mode transthoracic echocardiogram at discharge showing normalized left ventricular function with an ejection fraction of 55%

Figure 7

Histopathology of endomyocardial biopsy samples revealed lymphocytic myocarditis as demonstrated by the H and E

Figure 8

Immunohistology of endomyocardial biopsy samples confirmed diffuse infiltration of CD3+ T-cells