A 35-year-old Japanese woman was admitted with
coma following flu-like symptoms. She was diagnosed with
diabetic ketoacidosis and fulminant
type 1 diabetes (FT1D) and received
intravenous infusion of
insulin and saline. The next day, the
ketoacidosis disappeared, and she recovered consciousness. However, extensive ST-segment elevations in the electrocardiogram appeared with a positive
troponin test, and the patient developed
pulmonary edema on day 3. An echocardiogram showed globally reduced wall motion of the left ventricle and mild
pericardial effusion. Despite medical
therapy with intravenous
furosemide,
carperitide, and
catecholamines, her cardiac function deteriorated rapidly, with the left ventricular ejection fraction decreasing to 26% within 7 hours, and progressed to
cardiogenic shock that afternoon. The patient received mechanical circulatory support for 4 days with
intra-aortic balloon pumping and percutaneous cardiopulmonary support, and recovered fully from
circulatory failure. A paired serum antibody test showed a significantly elevated titer against parainfluenza-3 virus, indicating a diagnosis of fulminant viral
myocarditis. She was discharged on multiple daily
insulin injection
therapy, and her subsequent
clinical course has been uneventful. In summary, we present a case of concurrent FT1D and fulminant viral
myocarditis. Parainfluenza-3
viral infection was confirmed serologically and was considered to be a cause of both the FT1D and fulminant
myocarditis.