Although half of dilated cardiomyopathy (DCM) cases have unknown causes, the remaining causes of DCM are extensive. In some cases, DCM starts with myocarditis, which is basically an inflammation of the heart muscle. Myocarditis can present in a variety of ways, from asymptomatic to cardiogenic shock. Myocarditis is associated with a wide range of infections, most commonly viral, bacterial, and parasitic. The main mechanism seems to be immune-mediated damage to the myocardium, which leads to a global or local ventricular dysfunction and DCM. Epstein-Barr virus is a rare cause of myocarditis. We could locate only 15 cases (9 adults and 6 children) reported in the medical literature in English. We report an adult patient who presented with signs and symptoms of heart failure most likely secondary to myocarditis caused by Epstein-Barr virus infection. The diagnosis was made by viral serology and a multidisciplinary approach.
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