HISTORY: A 48-year-old female elite road cyclist attended an international conference in Europe and contracted a virus while living in an isolated wing of housing with athletes she coached. During week 2, a Gulf region athlete became ill with 103°F degree fever, SOB, chest pain, coughing and joint pain; 2 additional athletes also became ill. Nine days after initial exposure to the symptomatic cyclists, the patient expressed the same symptoms. Treatment began after she was flown back to the USA. Chest pain has continued for over 1 year with moderate exercise. PHYSICAL EXAMINATION: In 2014, the athlete presented to the ED with 1020F fever, SOB, chest pain (8/10), nausea, vomiting. Symptoms changed to Strider breathing, SOB, chest pain, vomiting and muscle cramping. The patient was transferred to isolation ICU then released home after stabilization. Chest pain returned after increasing HR during moderate exercise, resulting in another hospital admission. DIFFERENTIAL DIAGNOSIS: Myopericarditis, MERS. TEST AND RESULTS: Echocardiogram: 6/2014 - EF 35-40% with posterior lateral wall motion abnormalities; 10/2014 - EF 60%, wall motion WNLs; 6/2015 - EF 48%, posterior lateral wall motion abnormalities; 10/2015 - EF 58%, wall motion WNLs. Heart catherizations (cath) indicated the following: 5/2014 EF 28%, posterior lateral wall motion abnormalities; 6/2014 EF 50%, no wall motion abnormalities, RHC WNLs; 12/2014 - RHC WNLs, 9/2015 EF - WNLs, RHC. EKG RESULTS: 6/2014 - Sinus bradycardia, nonspecific ST-T wave changes; same in 10/2014, and 10/2015. GXT RESULTS: 10/2014 - peak VO2 of 33.7, 9/2015 - peak VO2 of 34.4 - both stopped due to chest pain. Troponin: elevated in 6/2014, 10/2014, 6/2015, 9/2015. No evidence of troponin on 10/2015.; cMRI - no evidence of scarring. FINAL WORKING DIAGNOSIS: viral myopericarditis TREATMENT AND OUTCOMES: Treatment consisted of colchicine, indomethacin, and pain medications as needed (dilaudid, Norco). As of 10/2015, the athlete still remains on PRN dilaudid and still has unexplained chest pain with moderate exercise. There has been both physical and psychological improvement over time and less breakthrough pain with moderate exertion.