Suspected Coccidioidomycosis (Valley Fever)–Associated Myocarditis with Refractory Ventricular Tachycardia in a Canine
Courtesy of Pamela Dragos DVM, CVA, CVCHM, CVMMP, Arizona, USA
Starky is a 9-year-old neutered male Rottweiler weighing 45.2 kg (99 lb) who presented with an acute, life-threatening cardiac tachyarrhythmia. He was diagnosed with coccidioidomycosis
(Valley Fever) in July 2025 and remained seropositive with IgG titers of 1:32 despite several months of fluconazole therapy. His medical history also included osteoarthritis and chronically
elevated liver enzymes. On the morning of November 5, 2025, Starky acutely developed heavy panting, pale gums and
tongue, cold extremities, lethargy, and unusual hiding behavior. He was taken to an emergency referral hospital, where he was hospitalized for approximately 32 hours and evaluated by a
cardiologist.
Emergency Findings and Hospital Course
On presentation, Starky was hypotensive with pale mucous membranes, weak asynchronous femoral pulses, and a severe tachyarrhythmia. His mentation was appropriate, but he was
markedly lethargic. Thoracic auscultation revealed no murmurs, and lung sounds were normal.
Electrocardiography demonstrated sustained ventricular tachycardia with concurrent atrial fibrillation. Echocardiography revealed no significant cardiomegaly, mildly reduced systolic function, and no obvious structural cause for the arrhythmia. These findings were interpreted as most consistent with acute myocarditis, with infectious myocarditis considered the leading differential diagnosis.
Despite aggressive intravenous therapy with lidocaine and magnesium, the arrhythmia could not be stabilized sufficiently to allow safe transition to oral medications. The emergency team
advised the owner that the prognosis was grave and that cardiac failure could occur within days.
Starky was discharged at the owner’s request with mexiletine and sotalol for arrhythmia control, prednisone and doxycycline, and antifungal therapy was transitioned from fluconazole
to posaconazole. Once home, Starky’s owner reported that he appeared more comfortable, happier, and more relaxed, and he began eating small amounts despite the guarded prognosis.
Integrative Consultation
An integrative consultation was requested on November 9, 2025.
At that time, Starky was intermittently playful but easily fatigued, panting frequently, constipated, and extremely selective with food. His appetite had declined significantly since his Valley Fever diagnosis several months earlier.
The problem list included suspected myocarditis, ventricular tachycardia, chronic coccidioidomycosis, hyporexia, constipation, anemia, azotemia, elevated liver enzymes, and
arthritis.
On Traditional Chinese Veterinary Medicine (TCVM) examination, Starky’s tongue was large and loose, mildly cracked, and bright pink-red, with a deep central groove extending from the
Stomach/Spleen region through the Heart region and a slight lavender hue in the Stomach/Spleen area.
The TCVM pattern diagnosis was Heart Qi deficiency, Spleen Qi deficiency with Damp, and Heat Toxin consistent with unresolved fungal infection
Treatment Goals
The primary treatment goals were to support myocardial energetics and electrical stability; resolve the underlying fungal infection (coccidioidomycosis) suspected to be causing
inflammatory myocarditis; modulate immune response to the chronic fungal infection; improve tolerance to antifungal and cardiac medications; reduce systemic inflammation and oxidative stress; and restore appetite and overall vitality.
Treatments
Chinese Herbal Medicine
Liu Jun Zi Tang was introduced to support Spleen Qi, autonomic regulation, and systemic resilience. This formula was selected for its usefulness in fatigue, hyporexia, anemia, immune dysregulation, renal disease, and cardiomyopathy and arrhythmias associated with Heart Qi and Yang deficiency. Liu Jun Zi Tang has been shown to modulate autonomic nervous system activity, including enhancement of vagal tone, and may thereby contribute to improved myocardial electrical stability and an increased arrhythmic threshold.
Cardiac Nutraceutical Support
A comprehensive heart support formula (Jing Tang Heart Support) containing acetyl L-carnitine HCl, L-taurine, vitamin E (D-alpha tocopheryl succinate), coenzyme Q10, Chinese salvia root (Salvia miltiorrhiza, Dan Shen), astragalus root (Astragalus membranaceus, Huang Qi), and Chinese hawthorn fruit (Crataegus pinnatifida, Shan Zha) was added to support myocardial energy production, circulation, antioxidant capacity, and conduction stability.
Immune and Antifungal Herbal Support
Canine Valley Fever Support, a custom herbal tincture, was added as an adjunct to conventional antifungal therapy. The formula consists of 1:5 tinctures of Isatis leaves and roots (Isatis
tinctoria), Echinacea angustifolia root, Platycodon root (Platycodon grandiflorus), Usnea barbata, Ligusticum root (Ligusticum spp.), and Andrographis leaves (Andrographis paniculata). This combination was selected to provide immune-modulating, anti-inflammatory, and antifungal support in the context of chronic coccidioidomycosis with suspected inflammatory myocardial involvement.
Adjunctive Support
Additional support included omega-3 fatty acids; medicinal mushrooms using Real Mushrooms Immune Chews (containing turkey tail Trametes versicolor, maitake Grifola frondosa, reishi Ganoderma lingzhi, shiitake Lentinula edodes, chaga Inonotus obliquus, standardized beta-[1,3][1,6]-D-glucans, ashwagandha Withania somnifera, astragalus root Astragalus membranaceus, blueberry powder Vaccinium angustifolium, acerola extract Malpighia emarginata, and olive leaf extract Olea europaea); vitamin B12 and folate; and a mineral blend containing calcium, magnesium, iron, strontium, sodium, manganese, phosphorus, potassium, and chromium to support cardiac conduction and metabolic function.
Dietary Therapy
A fresh, whole-food diet was emphasized as foundational therapy. Bone broth, fermented foods, and appetite-enhancing herbs (ginger, catnip, fennel seed, cinnamon, chamomile,
spearmint, and peppermint) were used to support gut integrity, immune modulation, and medication tolerance. Processed foods were avoided due to their association with oxidative
stress, inflammation, and advanced glycation end product formation.
Discussion
This case illustrates an uncommon but clinically significant presentation of suspected coccidioidomycosis-associated myocarditis manifesting as refractory ventricular tachycardia. In
endemic regions, Valley Fever should be considered as a potential contributor to inflammatory myocardial disease even in the absence of cardiomegaly or overt heart failure.
The absence of significant structural heart disease on echocardiography suggested an inflammatory rather than degenerative process, which may explain the patient’s subsequent clinical improvement. Integrative therapies were introduced as adjuncts to conventional management, addressing immune modulation, myocardial electrical stability, enhanced circulation, antifungal activity, mitochondrial support, oxidative stress, and gastrointestinal health.
Outcome
By mid-December 2025, approximately five weeks after initiation of integrative therapy, Starky’s owner reported a full return of energy and appetite. He resumed normal daily activity and
exhibited no further episodes of collapse or respiratory distress.
Follow-up blood work revealed persistently elevated alkaline phosphatase (2,787 IU/L), prompting scheduling of an abdominal ultrasound for further evaluation. Despite the need for ongoing monitoring, Starky’s quality of life improved dramatically compared with the initial
emergency prognosis.
Closing Remarks
This case underscores the importance of considering fungal myocarditis in dogs with unexplained ventricular arrhythmias in endemic regions and demonstrates that inflammatory myocardial disease may be reversible when systemic infection, cardiac conduction disturbance and immune dysregulation are addressed through a multimodal treatment approach. It is
notable that fungal myocarditis is almost always fatal and most commonly diagnosed on necropsy, making this case particularly significant given the patient’s clinical response and improved quality of life.
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