Myocarditis with multiorgan failure – 135 days fighting for life

Fulminant myocarditis is a rare, life-threatening condition that rapidly progresses to refractory cardiogenic shock requiring mechanical circulatory support. Prolonged extracorporeal life support increases survival but exposes patients to severe hemorrhagic, thromboembolic, and infectious complications. We present a complex case of fulminant myocarditis complicated by prolonged VA-ECMO support, massive transfusions, multidrug-resistant infections, and hepatic abscess formation. A 29-year-old man was admitted with fulminant myocarditis, severe biventricular failure (left ventricular ejection fraction 10%), atrial fibrillation, and combined cardiogenic and septic shock. He required mechanical ventilation, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), intra-aortic balloon pump (IABP), vasoactive support, and renal replacement therapy. Persistent bleeding from the ECMO site resulted in transfusion of 100 units of packed red blood cells over 110 days, complicated by mild transfusion-related acute lung injury. An occipital ischemic stroke without neurological deficits was diagnosed during hospitalization. Following successful VA-ECMO and IABP removal, the patient developed septic shock secondary to a groin wound infection caused by New Delhi metallo-β-lactamase-producing Klebsiella pneumoniae and Pseudomonas aeruginosa. Subsequently, multiple hepatic lesions suspicious for liver abscesses were identified. Percutaneous drainage yielded vancomycin-resistant Enterococcus faecium, prompting targeted antimicrobial therapy and transfer to a specialized hepatology center. Long-term veno-arterial extracorporeal membrane oxygenation serves as an effective bridge to recovery in patients with reversible profound circulatory failure. However, prolonged VA-ECMO support necessitates vigilant surveillance for hemorrhagic, thromboembolic, and infectious complications. A multidisciplinary management strategy is essential for optimizing clinical outcomes and patient prognosis.