Heart and Lung Involvement Detected by Cardiac Magnetic Resonance Imaging in a Patient with Legionella Pneumophila Infection: Case Report

Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a working diagnosis with heterogeneous etiology. Here we describe the diagnostic work-up in a patient with MINOCA in which cardiac magnetic resonance (CMR) imaging was instrumental in identifying myocarditis as the likely cause underlying clinical presentation. Furthermore, CMR revealed an unnoticed lung consolidation, guiding further examinations that led to Legionella Pneumophila antigens detection in urine. Finally, a diagnosis of Legionnaire’s disease with heart and lung involvement was hypothesized. We discuss the key role of CMR in MINOCA diagnostic work-up as well as the importance of extra-cardiac findings, which in this case were essential to unravel an uncommon and possibly overlooked cause of myocarditis.