AAOLCA in a Child Presenting With Fever and Cardiac Arrest: Diagnostic Overlap With Acute Myocarditis

Anomalous aortic origin of the left coronary artery (AAOLCA) is a rare congenital coronary anomaly causing myocardial ischemia and sudden cardiac death. Despite differing in pathophysiology from acute myocarditis, AAOLCA can present with a clinically indistinguishable acute picture.

We report an 11-year-old child with no prior cardiac history presenting with fever (40 °C), syncope, cardiac arrest, and cardiogenic shock. Elevated troponin and reduced ejection fraction initially suggested acute myocarditis, which could not be excluded. Atypical features-absent arrhythmia, rapid biomarker normalization, and fluctuating ventricular function-prompted further evaluation. Echocardiography and coronary angiography identified AAOLCA with a hemodynamically significant intramural segment; dynamic ischemia was confirmed during angiography. Surgical unroofing resulted in clinical recovery.

AAOLCA should be considered when pediatric myocarditis presents atypically. Echocardiography is essential. When concurrent myocarditis cannot be excluded, surgical timing should be individualized; here, a period of stabilization preceded definitive repair.