Cardiac Magnetic Resonance of Acute Myocarditis in an Human Immunodeficiency Virus Patient Presenting With Acute Chest Pain Syndrome

Abstract

A 34-year-old woman of Afro Caribbean origin presented to the HIV clinic with a few days’ history of chest pain, chills, and malaise. The chest pain was intermittent, severe, central, radiating to the left arm, worse on lying down, and better on sitting forward. This was preceded by an episode of collapse after palpitations a week earlier. On examination, she had a regular pulse of 84 bpm, blood pressure of 131/71 mm Hg, respiratory rate of 20, temperature of 38°C, and oxygen saturation of 99% on air. Cardiovascular, respiratory, abdominal, and neurological examinations were normal. ECG demonstrated anterolateral ischemic changes (Figure 1). Chest radiograph was normal. Figure 1. ECG showing anterolateral ischemic changes. Biochemical profile was as follows: C-reactive protein, 296 mg/dL; troponin, 3.8 ng/mL; CD4 count, 459; viral load, <50; and hemoglobin, 9.1 g/dL. Her antistreptolysin O titer was 1 in 40, and no antistreptolysin antibodies were detected. Viral titers were negative for cytomegalovirus, adenovirus, Coxiella burnetii , chlamydia (group) and Mycoplasma pneumoniae , enterovirus (including echoviruses, coxsackie …