# Complete Heart Block: A Rare Initial Presentation of Epstein-Barr Virus-Induced Myocarditis

## TL;DR

A 51-year-old diabetic patient presented with complete heart block due to Epstein-Barr virus-induced myocarditis, highlighting the need for early detection of rare cardiac complications.

## Contribution

This case report highlights a rare initial presentation of EBV-induced myocarditis with complete heart block.

## Key findings

- The patient showed elevated CRP, BNP, troponin, and CK levels, along with complete heart block on ECG.
- Cardiac MRI confirmed myocarditis, and EBV was identified as the underlying cause.
- Treatment with prednisone, acyclovir, and a pacemaker was effective.

## Abstract

Myocarditis, a rare but serious condition often caused by viral infections, rarely manifests with cardiac involvement in healthy individuals infected with Epstein-Barr virus (EBV). We present a case of a 51-year-old diabetic presenting with exertional dyspnoea, pleuritic chest pain, and intermittent fever. Investigations revealed elevated C-reactive protein (CRP), brain natriuretic peptide (BNP), high sensitive troponin, creatine kinase (CK) levels, and complete heart block on ECG. Echocardiography showed reduced ejection fraction and cardiac MRI confirmed myocarditis. Epstein-Barr virus was confirmed as the underlying cause. He was treated with prednisone, acyclovir, and a permanent pacemaker. Due to serious complications associated with myocarditis such as acute heart failure and arrhythmias, it is imperative to emphasize the importance of early recognition and timely intervention of atypical presentations.