Case 27. A 9-Year-Old Boy with Abdominal Pain, Vomiting, Lethargy, Headache, and Fever for 2 Days: Coxsackievirus Myocarditis

Coxsackievirus B is the most common etiology associated with viral myocarditis. Usually with a history of a recent respiratory or gastrointestinal illness (anorexia, abdominal pain, and vomiting) within the previous 2 weeks. Severe abdominal pain, often accompanied by gastrointestinal symptoms and fever, may be the first and most prominent symptom of myocarditis. Children with gastrointestinal symptoms may be a predictor poor prognosis. A high index of suspicion in children with nonspecific symptoms is mandatory for an early diagnosis and an adequate management for children with myocarditis. Timely use of ECMO can improve the survival rate in children with acute fulminant myocarditis when conventional treatment failed.