Fulminant Myocarditis With Normal Inflammatory Markers

Fulminant myocarditis is a rare, rapidly progressive and life-threatening condition requiring early diagnosis and management.

We present the case of a 31-year-old man who presented with sudden onset chest pain; though his initial echocardiography was largely unremarkable, and angiography ruled out acute coronary syndrome, the patient developed worsening pain with rising high-sensitivity troponin markers. Cardiac magnetic resonance imaging revealed widespread transmural late gadolinium enhancement throughout the left ventricle, which prompted urgent transfer to a quaternary center before the patient's acute deterioration. The patient deteriorated from symptom onset to overt cardiogenic shock requiring intubation, mechanical circulatory support, and high-dose immunosuppression within 25 hours.

This case underscores the importance of multimodality imaging for rapid decision-making in diagnosing myocarditis, particularly when clinical suspicion is high despite initial nonspecific biochemical tests and echocardiography.