A case of Epstein-Barr virus-caused fulminant myocarditis in a middle-aged man was successfully treated with VA-ECMO combined with medication therapy, with etiology confirmed by metagenomic next-generation sequencing detection of EBV DNA.
Key Findings
Background
Fulminant myocarditis caused by Epstein-Barr virus infection was confirmed in a middle-aged male patient presenting with respiratory and circulatory failure.
The patient presented with abrupt, diffuse cardiac inflammation precipitating rapid-onset hemodynamic collapse
EBV was identified as the causative agent, which is described as rare and infrequently reported as a cause of fulminant myocarditis
The case involved a middle-aged man, a demographic not typically highlighted in prior EBV-related myocarditis reports
Results
Clinical diagnosis of fulminant myocarditis was established through a combination of clinical signs, electrocardiography, echocardiography, and markedly elevated inflammatory and myocardial injury biomarkers.
Diagnostic workup included ECG and ECHO findings consistent with fulminant myocarditis
Inflammatory factors were described as 'significantly elevated'
Myocardial injury markers were also described as 'significantly elevated'
The combination of these findings together constituted the clinical diagnosis
Methods
The etiological diagnosis of Epstein-Barr virus was confirmed using metagenomic next-generation sequencing (mNGS) detection of EBV DNA.
mNGS was the specific diagnostic method used to identify EBV as the causative pathogen
EBV DNA was detected via mNGS, providing molecular confirmation of the etiology
mNGS represents an advanced diagnostic approach capable of identifying pathogens that may be missed by conventional testing
Results
The patient was successfully treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in combination with medication therapy.
VA-ECMO was employed as a mechanical circulatory support strategy in the setting of hemodynamic collapse
Treatment was described as a combination of VA-ECMO and pharmacological therapy
The patient achieved a successful outcome, surviving what is described as a 'highly lethal syndrome'
Early circulatory support is identified as a key factor in averting fatal outcomes
Conclusions
The authors conclude that the risk of fulminant myocarditis precipitated by EBV infection should not be underestimated, and that prompt recognition, targeted therapy, and early circulatory support may avert fatal outcomes.
Fulminant myocarditis is characterized as 'a highly lethal syndrome'
The authors emphasize that EBV as a cause of FM is rare and infrequently reported, suggesting under-recognition in clinical practice
Three key elements for improved outcomes are identified: prompt recognition, targeted therapy, and early circulatory support
What This Means
This report describes a single case of a middle-aged man who developed fulminant myocarditis — a sudden, severe inflammation of the heart muscle — caused by Epstein-Barr virus (EBV), the same virus responsible for mononucleosis ("mono"). This condition caused his heart to fail rapidly, leading to respiratory and circulatory collapse. Doctors confirmed EBV as the cause using an advanced genetic testing method called metagenomic next-generation sequencing (mNGS), which can identify pathogens from patient samples by analyzing all DNA present.
The patient was treated with a combination of medications and a life-support machine called VA-ECMO (veno-arterial extracorporeal membrane oxygenation), which temporarily takes over the work of the heart and lungs. This aggressive approach was successful, and the patient survived. The use of mNGS was critical in identifying EBV as the cause, as this virus is an uncommon and often overlooked trigger for such severe heart inflammation.
This research suggests that EBV should be considered a potential cause of fulminant myocarditis, even in middle-aged adults, and that clinicians should not underestimate this risk. Early use of advanced diagnostics like mNGS to identify the cause, combined with rapid deployment of mechanical heart support such as VA-ECMO, may be important factors in saving lives in these rare but dangerous cases.
Yu W, Huang H, Li R, Deng S. (2026). A Rare Case of Fulminant Myocarditis Caused by Epstein-Barr Virus Infection in a Middle-Aged Man.. Clinical laboratory. https://doi.org/10.7754/Clin.Lab.2025.250931