Myopericarditis is common in clinical practice and may be caused by infectious or noninfectious agents. [1][2][3][4][5][6][7][8][9][10][11][12] Patients with myopericarditis should be differentiated with others clinical setting. [13][14][15][16][17] A 36-year-old pregnant patient was admitted to our Gynecology and Obstetrics Department during the 33rd week of gestation due to fever and chills. She complained of a sore throat and fever of up to 398C, which lasted for 1 day before admission. She had no known history of exposure to sick children or adults with possible group A streptococcal (GAS) pharyngitis or tonsillitis. At admission physical examination, her blood pressure was 90/60 mmHg with a regular heart rate of 100 beats per minute, a body temperature of 40.08C and a respiratory rate of 28 breaths per minute. Cardiac objective examination was normal. As clinical and ultrasound examination showed fetal distress and initial labor of a premature birth, the patient underwent a Caesarean section after prophylaxis with intravenous antibiotics. GAS was isolated from blood culture and cultural examination of the placenta. Several hours later, the patient was transferred to the intensive care unit (ICU) with a working diagnosis of generalized sepsis. On ICU admission, laboratory findings showed clear signs of disseminated intravascular coagulation (DIC) and multiorgan failure (MOF). As thoraco-abdominal CT scan demonstrated a large abdominal abscess, an explorative laparotomy was carried out, showing wide necrosis of both the ovaries. A total hysterectomy and bilateral salpingooophorectomy was then performed.The next day, the patient experienced an oppressive, nonradiating chest pain, and she gradually developed congestive heart failure, with the onset of pulmonary edema, O 2 desaturation, hypotension and oligo-anuria.Laboratory findings showed elevated cardiac enzymes (creatine kinase: 3931 U/l, CK-MB: 22.0 ng/ml, cardiac troponin T 3.23 ng/ml, myoglobin 706 ng/ml). Electrocardiography (ECG) demonstrated sinus tachycardia with a 1-2 mm ST-segment elevation in leads V1-V2 and aVR, and a 1 mm ST-segment depression in leads II, III and aVF (Fig. 1). Transthoracic echocardiography (TTE) showed increased left-ventricular end-diastolic diameter with diffuse myocardial hypokinesia, left-ventricular (LV) ejection fraction (LVEF) of 20% and mild pericardial effusion.The patient was then transferred to the ICU of our Cardiology Department with the working diagnosis of acute myopericarditis following generalized sepsis. Recompensation was gradually reached by using intravenous antibiotics, diuretics and inotropic agents, including dopamine, dobutamine and norepinephrine, fresh frozen plasma and platelet concentrates. Serial ECG showed the typical changes of acute myopericarditis, with an initial ST-segment elevation and later deep Twave inversion. Serial daily-performed TTE showed a progressive slight improvement of LV function and contractility. Cardiac enzyme levels were normalized on the 9th day after ICU admission, coagul...