Complete Heart Block: A Rare Initial Presentation of Epstein-Barr Virus-Induced Myocarditis

Myocarditis, a rare but serious condition often caused by viral infections, rarely manifests with cardiac involvement in healthy individuals infected with Epstein-Barr virus (EBV). We present a case of a 51-year-old diabetic presenting with exertional dyspnoea, pleuritic chest pain, and intermittent fever. Investigations revealed elevated C-reactive protein (CRP), brain natriuretic peptide (BNP), high sensitive troponin, creatine kinase (CK) levels, and complete heart block on ECG. Echocardiography showed reduced ejection fraction and cardiac MRI confirmed myocarditis. Epstein-Barr virus was confirmed as the underlying cause. He was treated with prednisone, acyclovir, and a permanent pacemaker. Due to serious complications associated with myocarditis such as acute heart failure and arrhythmias, it is imperative to emphasize the importance of early recognition and timely intervention of atypical presentations.