ST-elevation in ethylene glycol toxicity mimicking myocardial infarction

Electrocardiographic changes due to ethylene glycol toxicity are described in a 37-year-old woman who presented with intentional overdose. She received prompt treatment with dialysis and fomepizole, which reversed profound metabolic acidosis. ST-elevation in leads I, aVL, and aVR were observed 87 h after admission along with diffuse repolarization abnormalities. Coronary angiography found no evidence of coronary artery disease, and echocardiogram revealed normal left ventricle size and a mildly hypokinetic basal inferior wall. Diffuse repolarization abnormalities persisted for several days. Review of literature supports the diagnosis of myocarditis induced by toxic metabolites of ethylene glycol in context of hepatic and renal failure.