Viral Myocarditis Mimicking ST-Segment Elevation Myocardial Infarction Complicated by Thrombocytopenia and Vasculitic Peripheral Neuropathy

Abstract

Symptomatic myocarditis is classically featured by a flu-like prodrome, dyspnea on exertion, palpitations, substernal chest pain, and abnormal electrocardiogram (ECG). The clinical diagnosis has often been challenging due to its similarities to acute coronary syndrome. Our case involved a patient who presented with claudication of bilateral lower extremity and ST-segment elevation myocardial infarction (STEMI) in the inferior leads. On cardiac catheterization, nonobstructed coronary arteries with left ventricular ejection fraction (LVEF) of 30% were demonstrated. His clinical presentation was consistent with suspected myocarditis, and he improved with immunosuppression. In addition, his thrombocytopenia and severe symptoms of peripheral neuropathy responded to both immunotherapy and anticoagulation. This case highlights the interplay between history taking, physical examination, and multimodal diagnostic imaging.

Keywords: cardiology; myocarditis; pulmonary critical care.

Figure 1.

Electrocardiogram recorded at admission showed ST-segment elevation in the inferior wall leads II, III, and aVF.

Figure 2.

Physical exam revealed acral areas of punctate erythema and blue discoloration on plantar surface and digits of feet.

Figure 3.

Review of the electrocardiogram on the sixth day of hospitalization demonstrated ST-segment normalization without Q waves in prior elevated leads I, aVL, II, III, aVF, and V4-6. An incomplete right bundle branch block was present.