An Unusual Case of Allograft Neutrophilic Myocarditis Mimicking Acute Myocardial Infarction in a Post-Heart Transplant Patient

The clinical presentation of myocarditis is variable and can mimic myocardial infarction. The diagnosis of acute myocarditis is frequently empiric, and is made on the basis of the clinical presentation, electrocardiographic changes, elevated cardiac enzymes, and lack of epicardial coronary artery disease and lymphocytic infiltration on myocardial biopsy. We present an unusual case of a young patient with history of heart transplantation who presented with fever and polyarthritis and developed chest pain along with electrocardiographic changes and troponin elevation with no evidence of coronary artery disease. His myocardial biopsy revealed marked neutrophilic infiltration and no evidence of rejection. The clinical picture was compatible with a rare finding of neutrophilic myocarditis in the allograft, possibly related to a systemic inflammatory process.