Rapidly Progressive Myocarditis and Cardiogenic Shock

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Systemic sclerosis-associated fulminant myocarditis with cardiogenic shock (n=1). Intervention: Immunosuppressive therapy and mechanical circulatory support. Primary outcome: Clinical course and survival.

Q: What does this research mean for the field?

Fulminant systemic sclerosis-associated myocarditis carries a grave prognosis and can result in fatal cardiogenic shock refractory even to dual mechanical circulatory support. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Fatemeh Mohammad; Noora Alhajri; Nadya Al-Matrooshi; Mohammed EL-Khashab

doi:10.1016/j.jaccas.2026.108578

July 1, 2026JACC Case ReportsOpen Access

Rapidly Progressive Myocarditis and Cardiogenic Shock

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Key result

Fulminant systemic sclerosis myocarditis proves fatal despite aggressive immunosuppression and mechanical circulatory support.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Cardiac involvement in systemic sclerosis is under-recognized and can present as fulminant myocarditis with cardiogenic shock and poor outcomes.

Key Points

Describe a case of fulminant myocarditis causing refractory cardiogenic shock in systemic sclerosis to highlight the diagnostic and therapeutic challenges of autoimmune cardiac involvement.
Evaluated a 49-year-old woman with diffuse systemic sclerosis who presented with progressive dyspnea, hypotension, and respiratory distress.
Assessed cardiac function using electrocardiography, echocardiography, cardiac magnetic resonance imaging, and endomyocardial biopsy.
Provided management using inotropes, diuretic agents, and dual mechanical circulatory support with venoarterial extracorporeal membrane oxygenation and an Impella CP device.
Laboratory testing showed high-sensitivity troponin of 1,854 to 1,887 ng/L and N-terminal pro–B-type natriuretic peptide of 26,615 pg/mL, with echocardiography demonstrating acute biventricular systolic dysfunction.
Cardiac magnetic resonance revealed diffuse biventricular myocardial inflammation, which was confirmed by endomyocardial biopsy showing lymphocytic infiltration.
Despite dual mechanical circulatory support, myocardial recovery did not occur, high-dose immunosuppression was delayed, and the patient died of multiorgan failure in the sixth week of hospitalization.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 49-year-old woman with diffuse systemic sclerosis who developed fulminant myocarditis and refractory cardiogenic shock, ultimately dying after 54 days in the ICU.

I

Intervention

Venoarterial extracorporeal membrane oxygenation (VA-ECMO), Impella CP, and immunosuppressive therapy (pulse corticosteroids, cyclophosphamide, IVIG).

O

Outcome

Clinical course and survival

Limitations

Single case report
No follow-up available because the patient died during the index hospitalization

Implication

Fulminant SSc-myocarditis carries a grave prognosis and requires early recognition and coordinated multidisciplinary care.

Abstract

BACKGROUND: Cardiac involvement in systemic sclerosis (SSc) is under-recognized and may present as fulminant myocarditis with cardiogenic shock and poor outcomes. CASE SUMMARY: A 49-year-old woman with diffuse SSc presented with progressive dyspnea and hypotension. Laboratory testing showed markedly elevated cardiac biomarkers, and echocardiography demonstrated severe biventricular systolic dysfunction. Electrocardiography revealed sinus tachycardia with right bundle branch block. Cardiac magnetic resonance showed diffuse biventricular myocardial inflammation, confirmed by endomyocardial biopsy demonstrating lymphocytic infiltration. DISCUSSION: Despite inotropes, diuretic agents, and dual mechanical circulatory support with venoarterial extracorporeal membrane oxygenation and an Impella CP device, myocardial recovery did not occur. High-dose immunosuppression was delayed, and heart transplantation was deferred because of cavitary lung lesions. The patient developed progressive multiorgan failure and died in the sixth week of hospitalization. TAKE-HOME MESSAGE: Fulminant SSc-myocarditis carries a grave prognosis and requires early recognition and co-ordinated multidisciplinary care.

Discussion

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Cite This Study

Mohammad et al. (2026) conducted a case report in Systemic sclerosis-associated fulminant myocarditis with cardiogenic shock (n=1). Immunosuppressive therapy and mechanical circulatory support was evaluated on Clinical course and survival. Fulminant systemic sclerosis-associated myocarditis resulted in rapidly progressive biventricular failure, refractory cardiogenic shock, and death despite aggressive immunosuppression and mechanical circulatory support.

synapsesocial.com/papers/6a54a170da93060f8148c30c https://doi.org/10.1016/j.jaccas.2026.108578

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Rapidly Progressive Myocarditis and Cardiogenic Shock

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Rapidly Progressive Myocarditis and Cardiogenic Shock

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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