Abstract
A 21-year-old man who was diagnosed with acute myocarditis was referred to our hospital in a state of cardiogenic shock. He was treated with carperitide, steroid therapy, and intra-aortic balloon pumping for hemodynamic support under mechanical ventilation. Despite the initial therapy, hemodynamic conditions rapidly deteriorated and the patient had a cardiac arrest on day 12. We initiated percutaneous cardiopulmonary support with mild therapeutic hypothermia, following which his hemodynamics improved with favorable neurological recovery. On day 16, the cannulation sites of the left superficial femoral artery (SFA) and the right femoral vein were closed; however, refractory bleeding from the surgical wounds suddenly occurred on days 24 and 29, and the patient underwent emergent angioplasty of the left SFA with a right great saphenous vein patch. The surgically-resected specimen from the left SFA revealed extensive vessel necrosis with bacterial organisms, but no neutrophil infiltration. These results suggested that the high-dose steroid use and therapeutic hypothermia led to poor wound healing caused by immunosuppression. The patient recovered during careful rehabilitation and was discharged from the hospital on day 73.
