Severe acute left ventricular dysfunction in multiple sclerosis: a case report and review of the literature.

We describe the case of a 36-year-old patient with multiple sclerosis (MS) who was admitted to the intensive care unit in a state of cardiogenic shock. Echocardiography showed severe left ventricular failure with ejection fraction of 10\%. After 10 days from the beginning of symptoms, she recovered completely. The coronary angiography was normal, endomyocardial biopsy not diagnostic. Cardiac magnetic resonance imaging did not show alterations secondary to a myocardial inflammation. In the previous 10 months, a lesion of the left cerebellar peduncle was diagnosed and she had some common autonomic disorders. Although a viral myocarditis is the most likely cause of acute cardiac dysfunction followed by complete recovery in a few days, in this case, the contradictoriness of data supporting the hypothesis of an infective disease suggests other possible causes, such as an acute autonomic system impairment, a rare eventuality that is suspected to coexist with MS.