Fulminant myocarditis complicated with left ventricular thrombus: a case report with complete functional recovery

Abstract

Fulminant myocarditis (FM) is a rapidly progressive, life-threatening inflammatory cardiomyopathy requiring early recognition, mechanical circulatory support, and immunomodulation. We report a 41-year-old man with a 20-day prodrome of cough and fever who presented with severe dyspnea and biventricular dysfunction (ejection fraction 12%) with multiple left ventricular apical thrombi. Coronary angiography excluded obstructive disease, and influenza B IgM was positive. Intra-aortic balloon pump (IABP), methylprednisolone (200 mg/day), intravenous immunoglobulin (10 g/day), and anticoagulation were initiated. IABP was weaned on day 11, and cardiac magnetic resonance on day 13 confirmed left ventricular excessive trabeculation with persistent thrombi. Follow-up echocardiography on day 17 demonstrated complete thrombus resolution. The patient was discharged on day 19, and at 3-month follow-up, ejection fraction normalized to 51%. This case underscores that even severe FM with multiple left ventricular thrombi remains potentially reversible with aggressive multidisciplinary management.

Keywords

Fulminant myocarditis / left ventricular thrombus / immunosuppressive therapy / intra-aortic balloon counterpulsation

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