BACKGROUND
Fulminant myocarditis is a rare but severe and life-threatening cardiovascular complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Its sudden onset can result in severe heart failure, even in previously healthy adults. This report describes the case of a 35-year-old woman who presented with life-threatening fulminant myocarditis after coronavirus disease 2019 (COVID-19).
CASE REPORT
A 35-year-old previously healthy woman presented to the emergency department on the fourth day of acute constitutional symptoms with progressive dyspnea, severe chest pain, and cardiogenic shock. She had previously received a 2-dose primary series of the Sinovac COVID-19 vaccine. Initial evaluation showed pronounced elevation of cardiac biomarkers along with electrocardiographic abnormalities. Coronary angiography promptly excluded acute coronary occlusion. Following transient hemodynamic improvement with inotropic support, the patient developed rapid electrical deterioration 17 hours after admission, which manifested as polymorphic ventricular tachycardia characterized by a sine-wave-like QRS pattern that progressed to refractory ventricular fibrillation, cardiac arrest, and death. Echocardiographic findings, along with the hyperacute clinical course, were consistent with a diagnosis of probable fulminant COVID-19-associated myocarditis.
CONCLUSIONS
Fulminant myocarditis remains a rare but potentially fatal complication of SARS-CoV-2 infection, capable of causing rapid hemodynamic collapse and malignant electrical instability even in previously healthy individuals. Early recognition, supported by cardiac biomarkers and echocardiographic assessment, is essential to facilitate the timely initiation of aggressive supportive care and may improve clinical decision-making in acute settings.

Keywords: COVID-19; Myocarditis; Arrhythmias, Cardiac; Ventricular Dysfunction, Left; Case Reports