# The Masquerading Myocarditis: A Case of Late Recurrence of Acute Myocarditis Presenting as “Peripartum Cardiomyopathy”

## TL;DR

A case of acute myocarditis misdiagnosed as peripartum cardiomyopathy highlights the importance of accurate diagnosis using advanced imaging and serology.

## Contribution

This case report highlights the diagnostic challenge of late-recurrent myocarditis mimicking peripartum cardiomyopathy and emphasizes the role of cardiac MRI and serology.

## Key findings

- Cardiac MRI with late gadolinium enhancement confirmed myocarditis in a postpartum patient.
- Positive Coxsackie B5 and Epstein-Barr virus serologies supported the diagnosis.
- The case underscores the need for early recognition to prevent rapid clinical deterioration.

## Abstract

Myocarditis is a potentially fatal medical condition with varied etiologies. Peripartum cardiomyopathy (PPCM) refers to systolic dysfunction occurring toward the end of pregnancy or in the months following delivery; it is a diagnosis of exclusion. We present a patient with chest pain, bipedal edema, markedly elevated troponins, electrocardiogram (EKG) findings that were concerning for myocardial infarction, and a significantly reduced left ventricular ejection fraction (LVEF) on the echocardiogram. The patient's presentation in the postpartum period closely resembled peripartum cardiomyopathy and presented a peculiar diagnostic challenge to our team. The right diagnosis was possible with cardiac magnetic resonance imaging, which revealed late gadolinium enhancement. Additionally, the patient had positive Coxsackie B5 and Epstein Bar virus serologies. While the clinical course of the disease is often benign, it could rapidly deteriorate, so early recognition and diagnosis are important to ensure patients receive adequate therapeutic support.