Spectral computed tomography as a novel diagnostic tool for mushroom poisoning–induced myocarditis: a case report

Abstract Background Spectral computed tomography (CT) offers a promising ‘one-stop’ assessment for acute myocarditis, yet its diagnostic value in rare toxic aetiologies, such as mushroom poisoning, remains underexplored. Case summary A previously healthy 58-year-old man presented with acute heart failure and multiorgan dysfunction following Trogia venenata mushroom ingestion. Initial troponin was mildly elevated. Emergency spectral CT coronary angiography excluded obstructive disease. Crucially, delayed-phase quantitative mapping revealed a globally increased myocardial extracellular volume (ECV: 33%–40%), indicating diffuse interstitial injury despite unremarkable conventional iodine maps. This finding was subsequently validated by cardiac magnetic resonance (CMR), which also showed globally elevated native T1 and ECV without late gadolinium enhancement, confirming the diagnosis of diffuse interstitial myocarditis. Discussion This case underscores a pivotal role for spectral CT in diagnosing toxic myocarditis. It provides a rapid, comprehensive alternative when CMR is not readily available, uniquely quantifying diffuse injury via ECV mapping—a key biomarker that may be inconspicuous on conventional imaging. This ‘one-stop’ approach can expedite critical management decisions.