This case highlights the importance of high clinical suspicion for fulminant myocarditis in pediatric patients presenting with conduction abnormalities and shock, and the life-saving potential of early ECMO.
Alerts to possible fulminant myocarditis with heart block in pediatric celiac disease; leaves open causal association and need for prospective studies.
We present the case of a 14-year-old girl with a background of celiac disease and no other significant medical history who developed acute complete heart block and cardiogenic shock secondary to fulminant myocarditis. She presented with persistent vomiting and lethargy. An electrocardiogram (ECG) revealed ST-segment elevation. A bedside echocardiogram revealed global hypokinesia. She was found to be in complete heart block and showed biochemical evidence of multi-organ hypoperfusion. Management included emergency inotropic support, hyperkalemia treatment, and extracorporeal membrane oxygenation (ECMO). She made a remarkable recovery, with near normalization of cardiac function and resolution of arrhythmias. This case highlights the importance of high clinical suspicion for myocarditis in pediatric patients presenting with conduction abnormalities and shock.
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Khaja Shafiuddin (2025) studied this question.
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