Fulminant Myocarditis With Concomitant Mycobacterium tuberculosis Presenting as a STEMI

BACKGROUND: Fulminant myocarditis is a critical inflammatory cardiomyopathy that may resemble acute coronary syndrome. CASE SUMMARY: A 76-year-old Filipino man presented with acute chest pain, with initial electrocardiogram showing inferolateral ST-segment elevations and a right bundle branch block. Coronary angiography revealed no acute culprit lesion. He developed refractory cardiogenic shock requiring mechanical circulatory support. Endomyocardial biopsy confirmed lymphocytic myocarditis, while bronchoalveolar lavage showed Mycobacterium tuberculosis infection. Despite treatment for both conditions, he developed multiorgan failure and died. Laboratory results were suggestive of hemophagocytic lymphohistiocytosis. DISCUSSION: This is a rare case of fulminant myocarditis initially presenting as an ST-segment elevation myocardial infarction with no culprit vessel identified on angiography, highlighting the importance of early endomyocardial biopsy in cases of unexplained cardiogenic shock. TAKE-HOME MESSAGES: Fulminant myocarditis is a rare cause of cardiogenic shock, while hemophagocytic lymphohistiocytosis is a rare complication of tuberculosis. Multidisciplinary care is critical to diagnosing and treating these uncommon but morbid conditions.