A Case of Fulminant Myocarditis with Hemophagocytic Syndrome

A case is a 50-year-old male visited our hospital, because he had a fever and shortness of breath. His electrocardiogram showed ST elevation, echocardiogram showed anterior severe hypokinesis with 36% of ejection fraction (EF) and pericardial effusion, his blood test revealed hepatic and cardiac enzyme elevation. Emergency coronary angiography showed no significant coronary stenosis. During the examination, he had ventricular fibrillation, so he underwent tracheal intubation, IABP and PCPS were inserted. Myocardial biopsy revealed lymphocyte infiltration and he was diagnosed with viral myocarditis. His cardiac function was improved with intravenous immunoglobulin and continuous hemodiafiltration, withdrawal of PCPS on the third day, extubated on day 7 of the disease. However, he had a fever again from the 19th day of the disease, hepatic dysfunction and cytopenia were occurred from the 25th day of the disease, and on 28th day bone marrow biopsy was performed and he was diagnosed as virus-associated hemophagocytic syndrome (VAHS). His fever, hepatic injury, and cytopenia were improved with corticosteroid therapy and his cardiac function was also improved up to 60% of EF. Several reports showed the relationship between viral myocarditis and VAHS, but there are few lifesaving cases especially in fulminant myocarditis. This patient was thought to be a rescued rare case because his cardiac function was recovered at the onset of VAHS.