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Acute Med Surg. 2019 Feb 10;6(2):192-196. doi: 10.1002/ams2.394. eCollection 2019 Apr.

Influenza-associated septic shock accompanied by septic cardiomyopathy that developed in summer and mimicked fulminant myocarditis.

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The Emergency and Critical Care Center Mie University Hospital Tsu Mie Japan.
Department of Cardiology and Nephrology Mie University Graduate School of Medicine Tsu Mie Japan.
Department of Infectious Diseases Mie University Hospital Tsu Mie Japan.
Department of Hematology and Oncology Mie University Graduate School of Medicine Tsu Mie Japan.
Department of Pathology and Matrix Biology Mie University Graduate School of Medicine Tsu Mie Japan.



Fulminant myocarditis (FM) and septic cardiomyopathy (SC) are two different disease entities, and distinction between them is important. A 34-year-old man had refractory shock, multiple organ failure, and elevation of cardiogenic markers. Echocardiogram showed tachycardia with extended ST elevation, and a rapid test for influenza A virus was positive. He was admitted with suspected FM induced by influenza.


Echocardiography showed severe left ventricular dysfunction and dilatation, but no myocardial edema. Inconsistent with FM, a right heart catheter examination showed preserved cardiac output. Therefore, SC was considered and standard therapy for septic shock was initiated. He was stabilized in the first 72 h without mechanical circulatory support.


Influenza A infection can cause septic shock accompanied by SC. This condition is confusing in the clinical appearance of FM. However, SC shows critically different features of FM, and it might not occur in the epidemic period.


Fulminant myocarditis; influenza; sepsis‐induced cardiomyopathy; septic cardiomyopathy; septic shock

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