Suspected Tick-Borne Viral Infection-Associated Myocarditis Presenting with ST-Segment Elevation in V1–V3

A 59-year-old male presented to the emergency department with acute-onset chest pain described as precordial tightness radiating to the left upper extremity, persisting for approximately 24 hours. His symptoms were accompanied by several days of fever and generalized body aches. Laboratory evaluation revealed a marked inflammatory response and significantly elevated cardiac injury biomarkers. Electrocardiography (ECG) demonstrated ST-segment elevation with pathological Q waves in V1–V3, while angiography excluded obstructive coronary disease. The patient was treated with methylprednisolone, antiviral therapy (ganciclovir), empirical antibiotic therapy (ampicillin), and cardioprotective treatment including cyclic adenosine monophosphate meglumine for eight days. This regimen resulted in substantial improvement in clinical symptoms and laboratory parameters. This case highlights the diagnostic complexity of viral myocarditis presenting as myocardial infarction with non-obstructive coronary arteries, particularly in geographic regions endemic for tick-borne infections. A multidisciplinary approach involving cardiology, infectious disease expertise, and laboratory diagnostics is essential for timely intervention and optimal outcomes in patients with myocarditis presenting as myocardial infarction.

Keywords: Chest pain, fever, myocardial infarction, myocarditis, ST-segment elevation