Abstract
Fulminant myocarditis is a potentially fatal disease characterized by sudden onset of severe hemodynamic compromise and marked myocardial inflammation. Here we report the successful management of a patient with fulminant myocarditis using percutaneous cardiopulmonary support (PCPS) with plasma exchange (PE) and continuous hemodiafiltration (CHDF). A 9-year-old girl presented with severe fatigue, abdominal pain, and sustained vomiting following fever. Despite fluid replacement therapy under a provisional diagnosis of acute gastroenteritis, her condition worsened and echocardiography on day 2 demonstrated severe hypokinesia. Therefore, she was diagnosed as having acute myocarditis and transferred to the ICU. She then developed clouding of consciousness, with sudden onset of circulatory collapse. She was immediately intubated and PCPS was instituted, along with intensive administration of catecholamines, methylprednisolone pulse therapy, and high-dose gamma-globulin. In addition, PE and CHDF were started for removal of humoral mediators such as cytokines, and for management of hepatic failure. PCPS was removed on day 6, PE on day 5 and CHDF on day 13. She was weaned from mechanical ventilation on day 11, and finally discharged with no sequelae on day 61. Our experience with this case shows that circulatory support with PCPS combined with PE and CHDF is an effective approach for management of children with fulminant myocarditis.
