Influenza A positive but H1N1 negative myocarditis in a patient coming from a high outbreak region of new influenza

We present the case of a 21 year-old man holidaying on the Spanish island of Mallorca, a region of high outbreak of infections with a new influenza A/H1N1 virus. Symptomatic influenza A infection, but not H1N1 positive, led to myocarditis after intimate contact with a woman with positive H1N1 titer. The electrocardiogram showed T-wave inversions in II, III, aVF and V5, V6. Serum chemistry showed elevated levels of troponin T, increased creatine kinase (CK) and CK myocardial band. Cardiac magnetic resonance imaging revealed mid--myocardial and subepicardial hyperintensities in the lateral wall, and subepicardial and mid-myocardial areas of gadolinium enhancement in the inferior wall. Despite intimate contact with an H1N1 positive patient, the analyses on H1N1 (H1 A/Brisbane/59/07, H1 A/ /California/7/09swine) were negative, but were positive for common influenza (H3 A/Brisbane/ /10/07). Myocarditis is a rare clinical manifestation of influenza A infection.