Fulminant Myocarditis in a Previously Well Toddler

Abstract

Presentation
A 16-month-old girl presented with vomiting and increased work of breathing with two days of vomiting and poor oral intake, followed by increased work of breathing. She was pale, dehydrated, tachycardic, tachypneic with delayed capillary refill and mild respiratory distress.

Diagnosis
Investigations revealed metabolic acidosis, cardiomegaly on chest X-ray, and ECG changes. Enterovirus was identified, and echocardiogram confirmed severely impaired left ventricular function (EF 25%).

Treatment
The patient received fluid resuscitation, required mechanical ventilation, inotropic support, antibiotics, anticoagulation and long-term heart failure therapy.

Discussion
Fulminant myocarditis can present with subtle symptoms. In this case, early identification of cardiovascular compromise, abnormal cardiac markers, and rapid referral to intensive care were crucial. The patient recovered fully with normal cardiac function. This case shows the importance of early suspicion and aggressive management in children presenting with non-specific symptoms like vomiting and respiratory distress.