Focal myocarditis mimicking myocardial infarction in a patient with rheumatoid arthritis

Cardiovascular features in rheumatoid arthritis (RA) are common. However, RA associated with acute myocarditis is seldom described. Here, we report the case of a 58-year-old woman with rheumatoid arthritis and end stage renal disease who suffered chest tightness and diaphoresis during hemodialysis. The electrocardiogram showed ST elevations and the echocardiographic study revealed abnormalities of regional wall motion with moderate left ventricle dysfunction. Acute ST-elevation myocardial infarction was impressed according to clinical presentations and elevated cardiac enzymes. However, emergent coronary angiography revealed no significant coronary stenosis. Magnetic resonance imaging ultimately made the diagnosis of myocarditis. The patient improved gradually without immunosuppressive therapy. This case shows that conservative treatment is a feasible strategy for acute myocarditis in a patient with rheumatoid arthritis.