Acute Myocarditis Presenting as Neck Pain With Severe Systemic Inflammation

Acute myocarditis classically presents with chest pain, dyspnea, and arrhythmias; however, atypical and extracardiac presentations may delay recognition. We describe an unusual presentation characterized by unilateral neck pain, dysphagia, profound systemic inflammation, and reversible cardiogenic shock.

A 35-year-old previously healthy woman initially presented with unilateral neck pain, dysphagia, and constitutional symptoms without chest pain or dyspnea. She developed hypotension requiring vasopressors, marked leukocytosis, thrombocytopenia, transaminitis, elevated cardiac biomarkers, and severe left ventricular dysfunction (ejection fraction 30%). Cardiac magnetic resonance showed elevated native T1 values and extracellular volume suggestive of diffuse myocardial injury. After infectious causes were excluded, corticosteroid therapy resulted in complete recovery within 1 week.

Extracardiac symptoms initially obscured the diagnosis; parametric cardiac magnetic resonance mapping proved diagnostically valuable.

Myocarditis may present with atypical extracardiac inflammatory symptoms. Parametric cardiac magnetic resonance mapping can support diagnosis when conventional imaging findings are limited or absent.