# Acute Fulminant Myocarditis Secondary to Coxsackie B Virus

## TL;DR

A 53-year-old man with no prior health issues developed severe heart inflammation due to Coxsackie B virus, requiring intensive treatment and highlighting diagnostic and management challenges.

## Contribution

This case emphasizes the importance of clinical suspicion and repeat testing in diagnosing Coxsackie B virus-induced fulminant myocarditis.

## Key findings

- The patient's fulminant myocarditis was confirmed by a positive Coxsackie B viral titer after initial tests were negative.
- Late gadolinium enhancement on cardiac MRI supported the myocarditis diagnosis.
- Treatment included GDMT, steroids, and intravenous immunoglobulins, reflecting a nuanced management approach.

## Abstract

Fulminant myocarditis is a severe form of acute myocarditis, characterized by complications such as hemodynamic compromise, often requiring advanced mechanical support. It can occur as a result of infection, toxin exposure, or autoimmune processes. This is a case of a 53-year-old male with no past medical history who presented with one week of fever, shortness of breath, and upper respiratory symptoms and subsequently developed fulminant myocarditis, characterized by severe left ventricular dysfunction and cardiogenic shock requiring both inotropic and advanced mechanical support. Initial serological diagnostics were negative for a viral etiology; however, repeat testing, prompted by continued high clinical suspicion, subsequently yielded a positive Coxsackie B viral titer. The diagnosis of myocarditis was further supported by the specific distribution of late gadolinium enhancement (LGE) on cardiac MRI. We describe the nuanced management approach, including heart failure guideline-directed medical therapy (GDMT), high-dose steroids, and intravenous immunoglobulins. Additionally, we highlight the role of noninvasive diagnostics and the challenges in targeted management of fulminant myocarditis.