Autopsy and Case Reports
Autopsy and Case Reports
Article / Autopsy Case Report

Infant acute myocarditis mimicking acute myocardial infarction

Maher Jedidi, Samia Tilouche, Tasnim Masmoudi, Maha Sahnoun, Youssef Chkirbène, Sarra Mestiri, Lamia Boughamoura, Mohamed Ben Dhiab, Mohamed Kamel Souguir

Downloads: 74
Views: 6281


Myocarditis is an inflammatory disease of the myocardium with heterogeneous clinical manifestations and progression. In clinical practice, although there are many methods of diagnosis of acute myocarditis, the diagnosis remains an embarrassing dilemma for clinicians. The authors report the case of 9-month-old infant who was brought to the Pediatric Emergency Department with sudden onset dyspnea. Examination disclosed heart failure and resuscitation was undertaken. The electrocardiogram showed an ST segment elevation in the anterolateral leads with a mirror image. Cardiac enzyme tests revealed a significant elevation of troponin and creatine phosphokinase levels. A diagnosis of acute myocardial infarction was made, and heparin therapy was prescribed. The infant died on the third day after admission with cardiogenic shock. The autopsy showed dilatation of the ventricles and massive edema of the lungs. Histological examinations of myocardium samples revealed the presence of a marked lymphocytic infiltrate dissociating myocardiocytes. Death was attributed to acute myocarditis. The authors call attention to the difficulties of differential diagnosis between acute myocarditis and acute myocardial infarction especially in children, and to the important therapeutic implications of a correct diagnosis.


Myocarditis, Myocardial Infarction, Diagnosis, Differential, Infant Death


1. Zhang T, Miao W, Wang S, Wei M, Su G, Li Z. Acute myocarditis mimicking ST-elevation myocardial infarction: a case report and review of the literature. Exp Ther Med. 2015;10(2):459-64. PMid:26622337.

2. Pomara C, Villani A, D’Errico S, Riezzo I, Turillazzi E, Fineschi V. Acute myocarditis mimicking acute myocardial infarction: a clinical nightmare with forensic implications. Int J Cardiol. 2006;112(1):119-21. PMid:16310266.

3. Karjalainen J, Heikkilä J. Incidence of three presentations of acute myocarditis in young men in military service. A 20-year experience. Eur Heart J. 1999;20(15):1120-5. PMid:10413642.

4. Rossetti B, Nguisseu G, Buracci A, Migliorini L, Zanelli G. Myocarditis Mimicking an Acute Coronary Syndrome: a case related to Salmonella enteritis. Gastroenterol Res Pract. 2009;2009:1-2. PMid:19997519.

5. Abe T, Tsuda E, Miyazaki A, Ishibashi-Ueda H, Yamada O. Clinical characteristics and long-term outcome of acute myocarditis in children. Heart Vessels. 2013;28(5):632-8. PMid:23064719.

6. Amabile N, Fraisse A, Bouvenot J, Chetaille P, Ovaert C. Outcome of acute fulminant myocarditis in children. Heart. 2006;92(9):1269-73. PMid:16449512.

7. Harris TH, Gossett JG. Diagnosis and diagnostic modalities in pediatric patients with elevated troponin. Pediatr Cardiol. 2016;37(8):1469-74. PMid:27573217.

8. Cooper LT Jr. Myocarditis. N Engl J Med. 2009;360(15):1526-38. PMid:19357408.

9. Kühl U, Pauschinger M, Bock T, et al. Parvovirus B19 Infection Mimicking Acute Myocardial Infarction. Circulation. 2003;108(8):945-50. PMid:12925460.

10. van Nierop J, Limburg A, van Ofwegen-Hanekamp CEE. Myocarditis mimicking acute myocardial infarction. Neth Heart J. 2015;23(10):502-4. PMid:26178204.

11. Costantini M, Tritto C, Licci E, et al. Myocarditis with ST-elevation myocardial infarction presentation in young man: a case series of 11 patients. Int J Cardiol. 2005;101(1):157-8. PMid:15860403.

12. Ohman EM, Armstrong PW, Christenson RH, et al. Cardiac troponin T levels for risk stratification in acute myocardial ischemia. N Engl J Med. 1996;335(18):1333-41. PMid:8857016.

13. Lin C-H, Lin W-C, Ho Y-J, Chang J-S. Children with chest pain visiting the emergency department. Pediatr Neonatol. 2008;49(2):26-9. PMid:18947012.

14. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol. 2009;53(17):1475-87. PMid:19389557.

15. Caforio ALP, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636-48, 2648a-2648d. PMid:23824828.

Publication date:

584eac070e8825af4b4fbaaa autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections