Rapidly Progressive Fulminant Perimyocarditis Requiring Early Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support in a Previously Healthy Young Adult

Fulminant perimyocarditis is a rare but life-threatening inflammatory cardiomyopathy that can rapidly progress to cardiogenic shock. Early recognition and timely initiation of mechanical circulatory support are critical for survival. We report the case of a previously healthy young male who initially presented with chest pain and dyspnea and was treated for presumed pericarditis in the setting of a possible infectious process. He rapidly deteriorated with hypotension, hypoxia, and rising lactate, consistent with cardiogenic shock. Transthoracic echocardiography demonstrated reduced left ventricular systolic function, and coronary angiography revealed non-obstructive coronary arteries. The patient was emergently supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and Impella (Johnson & Johnson MedTech, New Brunswick, NJ, USA) for left ventricular unloading, along with inotropic support and high-dose corticosteroids. Hemodynamic assessment demonstrated elevated filling pressures despite apparently normal cardiac output, consistent with mechanically supported circulation. Endomyocardial biopsy confirmed acute myocarditis. The patient improved rapidly, allowing discontinuation of mechanical circulatory support by hospital day three and discharge by day nine. At one-month follow-up, he had returned to baseline functional status. This case highlights the rapid progression of fulminant perimyocarditis and supports early initiation of VA-ECMO as a bridge to recovery in refractory cardiogenic shock. The observed discordance between structural recovery and long-term functional outcomes underscores the importance of ongoing follow-up. Further studies are needed to define optimal management strategies and the role of adjunctive therapies.