Cytomegalovirus myocarditis in an immunocompetent patient.

Viral infections can lead to myocardial inflammation, resulting in acute myocarditis. Acute myocarditis is mostly self-limiting, but it can lead to severe dilated cardiomyopathy and rarely to acute cardiac tamponade. We report a rare case of myocarditis in a young immunocompentent male patient due to a recent cytomegalovirus (CMV) infection. The clinical presentation was an influenza-like syndrome, classical for a CMV infection, in combination with mild chest pain. Further exploration showed inflammation-compatible perimyocardial images on magnetic resonance imaging (MRI). Following the symptomatic perimyocardial inflammation, the patient developed an acute asymptomatic self-limiting CMV hepatitis, a rare combination. Moreover, there was a remarkable evolution of both clinical signs with first increasing cardiac enzymes due to myocarditis and later on development of acute hepatitis. In this case report, we present the typical MRI images of myocarditis and discuss the CMV cardiac effects as well as the combination of CMV myocarditis and hepatitis.