Acute Myocarditis Mimicking Reverse Takotsubo Cardiomyopathy

A 48 year-old man with type 1 diabetes mellitus was admitted to our hospital with diabetic ketoacidosis precipitated by a persistent 7-day febrile illness related to a viral upper respiratory infection. Two days after admission he had an episode of chest pain with a rise of troponin I up to 29 ng/mL but no ECG changes. Coronary angiography demonstrated minor plaque but no flow-limiting disease. Left ventriculography showed severe hypokinesis of basal and mid segments but preserved contractility of apical segments, consistent with a pattern of inverted Takotsubo cardiomyopathy (Figure 1A and 1D and online-only Data Supplement Movie I). The patient was then referred for cardiovascular magnetic resonance (CMR) imaging to determine the underlying cause of left ventricular impairment. Cine CMR imaging confirmed left ventricular wall …