2023 Volume 72 Issue 2 Pages 306-312
The patient was a male in his 40s. He suffered from breathing difficulty, as well as chest discomfort, chills, and fever. Advanced diffuse hypocontraction and left ventricular hypertrophy (LVH) were confirmed in the left ventricle by transthoracic echocardiography (TTE). Furthermore, hypocontraction in the right ventricle was confirmed as well. He was diagnosed as having fulminant myocarditis (FM) and referred to another hospital for treatment. Once transferred to the other hospital, his hemodynamics declined and he required percutaneous cardiopulmonary support (PCPS), and intra-aortic balloon pumping (IABP) was introduced. There was no significant coarctation in the coronary artery upon coronary angiography, so a myocardial biopsy was conducted from the right ventricle. Subendocardium and intramyocardial lymphocytes, as well as plasma-cell dominant inflammatory cell infiltrate, were histologically confirmed. Five days later, we were able to remove the PCPS and IABP. Improvements of the wall motion in both the left and right ventricles and the LVH were observed upon repeat TTE. LVH and left ventricular diffuse hypocontraction determined by ultrasound examination are said to be characteristic symptoms of FM, with only a few cases reported in which complications occurred in the right ventricle abnormal wall motion. In this case, we confirmed a decline in the right ventricle wall motion along with left ventricular hypocontraction and LVH. We encountered a rare case in which we were able to observe by ultrasound exams the course of FM in both the left and right ventricles due to an infection.
