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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Acute Myocarditis Presenting as Neck Pain With Severe Systemic Inflammation

  • Ayesha Fayyaz1
  • Sher Wali Khan2
  • Mariam Azam3
  • Madiha Rabbani3
  • Valaine Hewitt4
4 affiliations
  1. 1Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
  2. 2Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea
  3. 3Department of Internal Medicine, Mount Sinai Brooklyn, Brooklyn, New York, USA
  4. 4Department of Cardiology, Mount Sinai Brooklyn, Brooklyn, New York, USA
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Abstract

Background: Acute myocarditis classically presents with chest pain, dyspnea, and arrhythmias; however, atypical and extracardiac presentations may delay recognition. We describe an unusual presentation characterized by unilateral neck pain, dysphagia, profound systemic inflammation, and reversible cardiogenic shock.

Case Summary: A 35-year-old previously healthy woman initially presented with unilateral neck pain, dysphagia, and constitutional symptoms without chest pain or dyspnea. She developed hypotension requiring vasopressors, marked leukocytosis, thrombocytopenia, transaminitis, elevated cardiac biomarkers, and severe left ventricular dysfunction (ejection fraction 30%). Cardiac magnetic resonance showed elevated native T1 values and extracellular volume suggestive of diffuse myocardial injury. After infectious causes were excluded, corticosteroid therapy resulted in complete recovery within 1 week.

Discussion: Extracardiac symptoms initially obscured the diagnosis; parametric cardiac magnetic resonance mapping proved diagnostically valuable.

Take-Home Messages: Myocarditis may present with atypical extracardiac inflammatory symptoms. Parametric cardiac magnetic resonance mapping can support diagnosis when conventional imaging findings are limited or absent.

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Cite

BibTeXRIS
BibTeX
@article{fayyaz2026acute,
  title = {{Acute Myocarditis Presenting as Neck Pain With Severe Systemic Inflammation}},
  author = {Ayesha Fayyaz and Sher Wali Khan and Mariam Azam and Madiha Rabbani and Valaine Hewitt},
  journal = {JACC Case Reports},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jaccas.2026.109796},
  url = {https://doi.org/10.1016/j.jaccas.2026.109796},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Acute Myocarditis Presenting as Neck Pain With Severe Systemic Inflammation
AU  - Ayesha Fayyaz
AU  - Sher Wali Khan
AU  - Mariam Azam
AU  - Madiha Rabbani
AU  - Valaine Hewitt
PY  - 2026
DA  - 2026/08/18
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.109796
UR  - https://doi.org/10.1016/j.jaccas.2026.109796
AB  - Background: Acute myocarditis classically presents with chest pain, dyspnea, and arrhythmias; however, atypical and extracardiac presentations may delay recognition. We describe an unusual presentation characterized by unilateral neck pain, dysphagia, profound systemic inflammation, and reversible cardiogenic shock.  Case Summary: A 35-year-old previously healthy woman initially presented with unilateral neck pain, dysphagia, and constitutional symptoms without chest pain or dyspnea. She developed hypotension requiring vasopressors, marked leukocytosis, thrombocytopenia, transaminitis, elevated cardiac biomarkers, and severe left ventricular dysfunction (ejection fraction 30%). Cardiac magnetic resonance showed elevated native T1 values and extracellular volume suggestive of diffuse myocardial injury. After infectious causes were excluded, corticosteroid therapy resulted in complete recovery within 1 week.  Discussion: Extracardiac symptoms initially obscured the diagnosis; parametric cardiac magnetic resonance mapping proved diagnostically valuable.  Take-Home Messages: Myocarditis may present with atypical extracardiac inflammatory symptoms. Parametric cardiac magnetic resonance mapping can support diagnosis when conventional imaging findings are limited or absent.
SN  - 2666-0849
ER  -