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The report describes a 16-year-old female with classic STEMI symptoms: severe retrosternal chest pain, inferior-lead ST-segment elevations, and markedly elevated troponin I (18 ng/mL). Although urgent coronary angiography showed normal coronary arteries, concomitant fever, hypotension, profound leukocytosis (40,900/µL), and elevated procalcitonin (11.1 ng/mL) supported septic shock with secondary septic myocarditis. Antibiotics led to rapid improvement within 72 hours and complete resolution of ST-segment elevations.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/septic-myocarditis-masquerading-as-acute-inferior-st-elevation-myocardial-infarction/443538/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/septic-myocarditis-masquerading-as-acute-inferior-st-elevation-myocardial-infarction/443538.png","ImageObject",300,407,{"name":92,"@type":93},"Aurelia","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why was acute inferior STEMI suspected initially?","Question",{"text":113,"@type":114},"The patient had crushing substernal chest pain with inferior-lead ST-segment elevations on ECG and a significantly elevated troponin I level, which fit STEMI presentation.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What test shifted the diagnosis away from coronary occlusion?",{"text":118,"@type":114},"Urgent coronary angiography showed completely normal coronary arteries with no evidence of thrombosis or dissection, ruling out acute coronary syndrome.",{"name":120,"@type":111,"acceptedAnswer":121},"Which findings supported septic myocarditis despite negative blood cultures?",{"text":122,"@type":114},"Fever, hypotension, profound leukocytosis, markedly elevated procalcitonin, and clinical biomarker evidence guided the diagnosis toward septic shock with secondary septic myocarditis.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},443538,1791131427,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},1099514068365,"https://ap-avatar.wpscdn.com/avatar/10000253d8d9f28188e?_k=1776742907772140068","Review began 11/23/2025  \nReview ended 12/03/2025  \nPublished 12/06/2025  \n© Copyright 2025  \nLahiri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98607  \nOpen Access Case Report  \nSeptic Myocarditis Masquerading as Acute Inferior ST-Elevation Myocardial Infarction  \nSubrata Lahiri 1, Ovais Rashid 1, Anshu Goel 2, Arun Moondhra 3  \n1. Department of Cardiology, Sant Parmanand Hospital Civil Lines, New Delhi, IND 2. Department of Medicine, Pt. Madan Mohan Malaviya Hospital, New Delhi, IND 3. Department of Internal Medicine, Sant Parmanand Hospital Civil Lines, New Delhi, IND  \nCorresponding author: Subrata Lahiri, [drlahiri_s@yahoo.com](drlahiri_s@yahoo.com)  \nAbstract  \nAcute ST-elevation myocardial infarction (STEMI) is a rare and alarming presentation in adolescents, particularly in women. We report the case of a 16-year-old female who presented with classic symptoms of acute myocardial infarction, including severe retrosternal chest pain, ST-segment elevations on ECG, and a significantly elevated troponin I level (18 ng/mL) . The ECG showed evidence of ST elevation in inferior leads, suggestive of inferior STEMI. Urgent coronary angiography revealed normal coronary arteries, effectively ruling out coronary occlusion. The diagnostic pivot was guided by concomitant fever, hypotension, profound leukocytosis (40,900/µL), and a markedly elevated procalcitonin level (11 .1 ng/mL) . Blood cultures were negative. A transthoracic echocardiogram revealed severe global left ventricular dysfunction (35%) . Despite negative blood cultures, a diagnosis of septic shock with secondary septic myocarditis was made based on the overwhelming clinical and biomarker evidence. Initiation of antibiotic therapy led to rapid clinical improvement within 72 hours, accompanied by complete resolution of STsegment elevations. This case underscores septic myocarditis as a critical mimic of STEMI and highlights the importance of a normal angiogram in redirecting management toward life-threatening infectious etiologies.  \nCategories: Cardiology, Emergency Medicine, Internal Medicine  \nKeywords: acute phase response, cardiovascular disease, myocardial infarction, myocarditis mimicking stemi, pediatric clinical cardiology, sepsis-induced cardiomyopathy, septic shock in children  \nIntroduction  \nThe presentation of chest pain with ST-elevations on ECG mandates an immediate rule-out of acute myocardial infarction [1] . However, in young patients without cardiac risk factors, alternative diagnoses must be aggressively pursued. Myocarditis is a well-known impostor, accounting for a significant proportion of ST-elevation myocardial infarction (STEMI) mimics, particularly in adolescent and young adult populations [2] . The diagnostic challenge intensifies when myocardial inflammation occurs secondary to a systemic bacterial infection, a condition termed septic myocarditis. This entity involves acute myocardial dysfunction triggered by a systemic inflammatory cascade, often mimicking STEMI with striking accuracy in both its clinical presentation and electrocardiographic findings [3] . In such cases, the presence of fever, hemodynamic instability, and markedly elevated inflammatory biomarkers becomes a crucial diagnostic red flag, steering the clinical approach away from coronary occlusion and toward a life-threatening infectious etiology [4] .  \nCase Presentation  \nA 16-year-old female with no significant past medical history presented to the emergency department following a 24-hour prodrome of high-grade fever and chills, which culminated in the acute onset of crushing substernal chest pain radiating to her jaw. The pain was associated with severe shortness of breath, diaphoresis, and nausea. Upon admission, she was critically ill, with","cbCaisjyODpXnrJw","https://ap.wps.com/l/cbCaisjyODpXnrJw","pdf",6611882,"English","# Abstract\n# Introduction\n# Case Presentation","[{\"question\":\"Why was acute inferior STEMI suspected initially?\",\"answer\":\"The patient had crushing substernal chest pain with inferior-lead ST-segment elevations on ECG and a significantly elevated troponin I level, which fit STEMI presentation.\"},{\"question\":\"What test shifted the diagnosis away from coronary occlusion?\",\"answer\":\"Urgent coronary angiography showed completely normal coronary arteries with no evidence of thrombosis or dissection, ruling out acute coronary syndrome.\"},{\"question\":\"Which findings supported septic myocarditis despite negative blood cultures?\",\"answer\":\"Fever, hypotension, profound leukocytosis, markedly elevated procalcitonin, and clinical biomarker evidence guided the diagnosis toward septic shock with secondary septic myocarditis.\"}]","Septic Myocarditis Masquerading as Acute Inferior ST-Elevation Myocardial Infarction | PDF",1790704370,15]