A unique case of sepsis-triggered reverse Takotsubo cardiomyopathy resulting in cardiogenic shock.

Reverse Takotsubo syndrome (rTTS) is an acute cardiomyopathy characterized by prominent dysfunction in the basilar and mid-ventricular segments with apical hyperkinesis, often triggered by excessive stress hormone release. Sepsis can exacerbate this process. We present a unique case of a 27-year-old male with no chronic illnesses who developed sepsis-triggered rTTS resulting in cardiogenic shock. The initial presentation included nausea, vomiting, tachypnea, and fluctuating blood pressure. Laboratory findings revealed elevated cardiac and inflammatory markers, metabolic acidosis, and bacteremia caused by Staphylococcus aureus. Echocardiography showed an initial left ventricular ejection fraction (LVEF) of 45% with basal mid-ventricular hypokinesia and apical hyperkinesis, characteristic of rTTS. Coronary angiography excluded obstructive coronary artery disease. The patient developed cardiogenic shock (SCAI Stage D) requiring vasopressors and mechanical circulatory support with an Impella CP® device. Complications included acute kidney injury requiring renal replacement therapy and posterior reversible encephalopathy syndrome (PRES). With targeted antimicrobial therapy and supportive care, the patient's LVEF improved to 60-65%, and he made a significant clinical recovery. This case highlights the importance of recognizing sepsis as a trigger for rTTS and the potential for full recovery with prompt, aggressive management, including mechanical circulatory support.