Parvovirus B19-Induced Myocarditis Mimicking Acute Myocardial Infarction Clarification of Diagnosis by Cardiac Magnetic Resonance Imaging

An 18-year-old man with no previous cardiac history presented to his local hospital complaining of severe chest pain. One day before admission, he was hit in the chest by a ball during a basketball game. He did not notice any symptoms and was able to finish the game; however, the next day, he developed severe central chest pain. Cardiac troponins were elevated at 79 μg/L (normal range, 0 to 1.2 μg/L). He subsequently underwent cardiac catheterization, which showed normal coronary anatomy with no significant stenoses. Subsequently, he had another episode of chest pain that was associated with diffuse ST elevation involving the anterior and lateral leads. The ST elevation persisted for >90 minutes before subsiding spontaneously. On transfer, the patient was specifically questioned about recreational drug use. He denied any use of cocaine, although he did admit to using marijuana 1 week before admission. On examination, he was pain free and hemodynamically stable. An echocardiogram showed minimal persistent ST segment elevation in the anterior leads (Figure 1). A cardiac magnetic resonance imaging (MRI) scan (Magnetom TRIO, Siemens, Germany; field strength 3 T) was performed to assess morphology of myocardial injury. This scan demonstrated normal left ventricular size with mild left ventricular systolic dysfunction (Movie I in the online-only Data Supplement). Left ventricular ejection fraction was calculated at 42% using QMass® MR version 7.0.28 (Leiden, The Netherlands). There was severe hypokinesis of the …