Fever, Malaise, and Dyspnea in a Diabetic Heart Transplant Patient: AÂ Case Report

•Broad differential diagnosis is considered when heart transplant patients present with malaise.•Endomyocardial biopsy is mandatory in heart transplant patients with dysfunction.•Myocardial infarction is diagnosed once first suspicion (rejection) is ruled out.•Clinical presentation can mimic different complications in heart transplantation.

Patients with solid-organ transplants usually present at the emergency department with nonspecific symptoms. The physician should consider a great variety of syndromes and diseases, given the greater risk that solid-organ transplant patients carry because of immunosuppression and transplant-related conditions. Myocardial infarction caused by cardiac allograft vasculopathy must be always suspected and ruled out, even when initial symptoms do not orientate in that direction. We present a case that conjugates signs that can be present in different pathologies. It shows that fever is not always related to infection or rejection but could also appear in acute cardiac allograft vasculopathy. It emphasizes the need of a multi-disciplinary team led by a heart transplant specialist when dealing with this sort of clinical case.