Early stage Fabry cardiomyopathy misdiagnosed as perimyocarditis

A 56-year-old Caucasian woman was admitted to our ICU department because of chest pain and worsening dyspnea. Three months before, she had been admitted to a peripheric hospital for chest pain and high troponin levels. Echocardiography was normal and angiography showed no sign of coronary artery disease. She was discharged as having myocardial infarction with no obstructive coronary disease (MINOCA). After <1 month, she was referred again to the emergency department for the same symptoms. A cardiac magnetic resonance (CMR) subsequently performed showed a slight pericardial effusion and myocardial edema, albeit the presence of a single CMR criterion could not lead to a definite diagnosis of myocarditis. Suspected of having pericarditis, she was discharged with FANS and colchicine, and after 1week corticosteroids were added without any further improvement.