Challenges of Diagnosing Viral Myocarditis in Adolescents in the Era of COVID‐19 and MIS‐C

Abstract

Myocarditis has a wide array of clinical presentations ranging from asymptomatic to sudden cardiac death. Pediatric myocarditis is a rare disease, with an estimated annual incidence of 1 to 2 per 100,000 children though its true prevalence remains unknown due to its variable and often subclinical presentation. The diagnosis of myocarditis is challenging in the era of COVID‐19 and Multisystem Inflammatory Syndrome in Children (MIS‐C), which can have overlapping clinical conundrum. Here, we present a case of a 17‐year‐old male presenting with chest tightness, shortness of breath, and electrocardiogram (EKG) findings concerning for myocardial injury along with elevated inflammatory markers such as D‐dimer, ESR (Erythrocyte Sedimentation Rate), and CRP (C‐Reactive Protein). We discuss the key elements of our clinical experience with this case and review the literature for pediatric myocarditis, with a focus on differentiating it from MIS‐C in the current COVID‐19 pandemic era.