Elevated cardiac troponin secondary to heterophile antibodies: a case series highlighting an underrecognized differential

Background: Heterophile antibody presence confounds troponin assay results, causing falsely elevated troponin levels. This rare phenomenon is an important differential to consider when evaluating patients with suspected acute coronary syndrome. We present a case series of three patients with similar clinical presentations where the presence of heterophile antibodies was confirmed. Case summary: We reviewed three patients from our hospital who presented with chest pain in a 12-month period. All patients were males aged 50-70. All patients had elevated troponin, and there was clinical concern for acute coronary syndrome in two patients. Two patients underwent coronary angiography during admission, and the third had a recent angiogram within the last 6 months. No obstructive lesions were found, and no alternative diagnoses were identified. Ultimately, the presence of heterophile antibodies was confirmed in all three patients. Discussion: Heterophile antibody presence is an important differential to consider in patients with unexplained troponin elevation. Once the presence of heterophile antibodies is confirmed, this aids in clinician decision-making and helps to guide investigations and treatment in future.