Beyond the Coronary-Enteric Myocarditis Masquerading as Acute Coronary Syndrome with Cardiogenic Shock: A Rare Case of Successful Management despite Initial Misdiagnosis

This case report presents a rare occurrence of enteric myocarditis caused by Salmonella Typhi, initially mistaken for acute coronary syndrome in a 33-year-old woman who presented with chest pain and fever. Despite the severity of her condition, characterized by atrioventricular dissociation and cardiogenic shock, coronary angiography revealed normal coronary arteries, prompting a revised diagnosis of myocarditis associated with enteric fever. The patient was managed with antibiotics, inotropic support, and temporary cardiac pacing. Her cardiac function steadily improved over several weeks, as confirmed by cardiac magnetic resonance imaging and normalization of her electrocardiogram (ECG). Although uncommon, enteric myocarditis can be difficult to diagnose due to its diverse symptoms and clinical similarities with other cardiac conditions, particularly in areas where typhoid fever is prevalent. Early detection through ECG, echocardiography, and biomarkers such as the Widal test is essential for prompt treatment and better outcomes. This case highlights the need to consider rare cardiac complications in febrile patients and emphasizes the value of thorough diagnostic workups and individualized treatment approaches to prevent serious complications.