[Myocarditis in Olympic marathon runner].

One thousand five hundred runners participated in the Tiberias marathon in 2010 and more than 35,000 runners participate annuaLly in large city marathons. Elite marathon runners train strenuously, tending to ignore various symptoms of pain, aches and mild respiratory infections, as they continue training relentlessly for the upcoming marathons. Intensive training may weaken the immune system, thus increasing the susceptibility for infection, mainly viral infections. We present a case study of an Olympic marathoner, an Ethiopian of Jewish origin, aged 41 who began training for an upcoming marathon on May 1, 2010. During the following 6 weeks he ran 180-240 km/week at easy to moderate paces. In mid-June he added 2 high intensity runs per week to his running schedule. During the first 3 weeks, quality running improvement was noted, but then the runner started to feel muscle pains in his thighs, shortness of breath and chest uneasiness while running fast. The physical examination conducted on 19/7/10 was normal. Examinations showed white blood cell (WBC) count was 2800, 55% lymphocytes, 11.8% monocytes, titers for recent CMV, Epstein Bar, enteroviruses, were negative. On 24/7/10 ECG showed inverted symmetric T-wave in precordial leads, chest X-ray, echocardiogram, troponin, and WBC were normal. Clinical features, WBC, and ECG findings, suggested myocarditis, probably viral The runner stopped running. On 9/9/10 ECG was normal. On 15/9/10 cardiac virtual catheterization was normal. Cardio-pulmonary exercise test on 4/10/2011 was normal. Thereupon, the athlete resumed running. This case stressed the fact that physicians should be alert to medical complaints from marathoners, in order to prevent serious outcomes from dissimulate runners. A literature search was conducted related to distance runners and high level orienteer's myocarditis causes and prevention.