Heart Transplantation Under Biventricular Mechanical Circulatory Support for Fulminant Myocarditis After a Bee Sting: A Case Report

Patient: Female, 36-year-old Final Diagnosis: Cardiogenic shock • myocarditis Symptoms: Fever Medication: — Clinical Procedure: Mechanical circulatory support Specialty: Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Venom related fulminant myocarditis is uncommon. The clinical course varies, and histopathology is usually unclear, however, refractory cardiogenic shock is rare. CASE REPORT: We reported a case of a 36-year-old female who developed fever and cardiogenic shock 3 days after a bee sting. Cardiac angiography showed patent coronary arteries and severely compromised left ventricular function. Her hemodynamics remained unstable under high dose inotropic agents and intra-aortic balloon pump support. In-hospital cardiac arrest occurred 4 hours after admission and she received extracorporeal cardiopulmonary resuscitation. Her peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) was shifted to bilateral ventricular assisted devices (VAD) due to progressive right heart failure. The endomyocardial biopsy result was compatible with the picture of hypersensitivity myocarditis. Her heart went into persistent standstill under mechanical circulatory support. She underwent heart transplantation on hospital day 49 and remained clinically stable 6 months after discharge. CONCLUSIONS: This is the first reported case of fulminant hypersensitivity myocarditis following a bee sting. ECMO and VAD could be used as bridge to a successful heart transplantation.