Aims and background: Severe community-acquired pneumoniae (CAP) complicated by myocarditis presents a significant clinical challenge, particularly with uncommon pathogens such as Streptococcus pneumoniae. This case emphasizes the complexity of managing a young adult with refractory hypoxemia, type 2 respiratory failure, metabolic acidosis, and shock, highlighting the need for a multidisciplinary approach. Case description: A 26-year-old male with severe CAP complicated by myocarditis initially received lung-protective mechanical ventilation and vasopressor support. Despite these measures, the patient's condition worsened. Cardiac evaluation showed elevated biomarkers and regional wall motion abnormalities, indicating myocarditis. Coronary angiography ruled out significant coronary artery disease. The diagnosis was refined to severe CAP with streptococcal myocarditis and type 2 respiratory failure. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated, supporting both cardiac and respiratory functions. Further investigation revealed left lower lobe consolidation and S. pneumoniae in bronchoalveolar lavage (BAL) polymerase chain reaction (PCR), prompting targeted antibiotic therapy. Steroid treatment, in line with severe pneumoniae guidelines, led to clinical improvement. Transition to venovenous ECMO (VV-ECMO) facilitated successful extubation and significant recovery. Conclusion: This case underscores the importance of a multidisciplinary approach, combining advanced ECMO support, targeted antibiotics, and adaptive treatment strategies to manage severe respiratory and cardiac complications in critically ill patients, particularly with rare etiologies like streptococcal myocarditis. Clinical significance: Advanced ECMO support, along with precise therapeutic interventions, is crucial for improving outcomes in severe CAP with concomitant myocarditis. This case demonstrates the effectiveness of such an approach in addressing both respiratory and cardiac failures, offering a framework for future similar cases.