title: Infant acute myocarditis mimicking acute myocardial infarction.
abstract: Myocarditis is an inflammatory disease of the myocardium with heterogeneous clinical manifestations and progression. In clinical practice, although there are many methods of diagnosis of acute myocarditis, the diagnosis remains an embarrassing dilemma for clinicians. The authors report the case of 9-month-old infant who was brought to the Pediatric Emergency Department with sudden onset dyspnea. Examination disclosed heart failure and resuscitation was undertaken. The electrocardiogram showed an ST segment elevation in the anterolateral leads with a mirror image. Cardiac enzyme tests revealed a significant elevation of troponin and creatine phosphokinase levels. A diagnosis of acute myocardial infarction was made, and heparin therapy was prescribed. The infant died on the third day after admission with cardiogenic shock. The autopsy showed dilatation of the ventricles and massive edema of the lungs. Histological examinations of myocardium samples revealed the presence of a marked lymphocytic infiltrate dissociating myocardiocytes. Death was attributed to acute myocarditis. The authors call attention to the difficulties of differential diagnosis between acute myocarditis and acute myocardial infarction especially in children, and to the important therapeutic implications of a correct diagnosis.
authors.affiliation: Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia .
authors.forename: Maher
authors.initials: M
authors.lastname: Jedidi
authors.affiliation: Department of Pediatrics - Farhat Hached University Hospital, Sousse - Tunisia .
authors.forename: Samia
authors.initials: S
authors.lastname: Tilouche
authors.affiliation: Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia .
authors.forename: Tasnim
authors.initials: T
authors.lastname: Masmoudi
authors.affiliation: Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia .
authors.forename: Maha
authors.initials: M
authors.lastname: Sahnoun
authors.affiliation: Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia .
authors.forename: Youssef
authors.initials: Y
authors.lastname: Chkirbène
authors.affiliation: Department of Pathology - Farhat Hached University Hospital, Sousse - Tunisia .
authors.forename: Sarra
authors.initials: S
authors.lastname: Mestiri
authors.affiliation: Department of Pediatrics - Farhat Hached University Hospital, Sousse - Tunisia .
authors.forename: Lamia
authors.initials: L
authors.lastname: Boughamoura
authors.affiliation: Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia .
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ben Dhiab
authors.affiliation: Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia .
authors.forename: Mohamed Kamel
authors.initials: MK
authors.lastname: Souguir
keywords: Diagnosis, Differential; Infant Death; Myocardial Infarction; Myocarditis