Abstract
Fulminant myocarditis (FM) is an acute inflammatory condition that results in a rapidly progressive, life-threatening circulatory failure and cardiogenic shock. This condition is characterized by severe endotheliitis and concurrent cytokine storm, which give rise to a wide spectrum of clinical manifestations and complications, including thromboembolism, myositis, and arrhythmia. Herein, we report an extremely rare case involving a 48-year-old woman diagnosed with FM associated with influenza virus type A, presenting with abdominal aortic occlusion due to acute thrombosis. Echocardiography revealed a significant reduction in global cardiac function (left ventricular ejection fraction, 26%), accompanied by left ventricular mural thrombosis. Enhanced computed tomography (CT) and angiography revealed an in situ aortic thrombosis affecting the infrarenal abdominal aorta and branches of the superior mesenteric artery, bilateral common iliac arteries, and internal and external iliac arteries. The patient was provided with a comprehensive treatment involving anticoagulants (enoxaparin, tirofiban), immunomodulatory agents (methylprednisolone, immunoglobulin), antiviral agent (oseltamivir), and intra-aortic thrombus aspiration via the right femoral artery. After undergoing these treatments for 19 days, her cardiac function returned to normal and subsequent CT images showed a dramatic reduction in aortic thrombosis. Moreover, full recovery of blood flow and movement function of the bilateral lower extremities was observed.