A rare case of arrhythmogenic right ventricular cardiomyopathy mimicking as myocarditis: A diagnostic pitfall

ABSTRACT This report describes an instructive case of a 29-year-old man who presented with features suggestive of acute myocarditis but was ultimately diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC), highlighting the diagnostic challenge of distinguishing between the two conditions. He came to the emergency department with chest pain and dizziness following a recent febrile illness. Evaluation included cardiac biomarkers, serial electrocardiograms, echocardiography, and cardiac magnetic resonance imaging (CMR). He initially developed pulseless ventricular tachycardia requiring emergency synchronized cardioversion. Investigations revealed markedly elevated cardiac enzymes, and echocardiography demonstrated global left ventricular (LV) systolic dysfunction. CMR revealed severe right ventricular dysfunction with characteristic features of ARVC, along with global LV dysfunction. This case underscores that ARVC may mimic acute myocarditis, particularly in young patients with ventricular arrhythmias and inflammatory symptoms. CMR plays a vital role in distinguishing these conditions and can identify features of ARVC that might otherwise be missed. Early recognition is essential for guiding appropriate management and initiating family screening.