A Diagnostic Dilemma from a Presentation of Shortness of Breath and Chest Pain

Introduction: A patient presented to hospital with chest pain and shortness of breath on 2 occasions 4 weeks apart. Clinical examination revealed an elevated jugular venous pressure consistent with heart failure or elevated filling pressures. Methods: The patient was investigated through various modalities including electrocardiogram (ECG), transthoracic echocardiogram, coronary angiography, M RI, cardiac catheterization, positron emission tomography, and an extensive laboratory workup. Results: Serial hs Tnl measurements consistently revealed grossly elevated troponin I (>10 000 ng/L). In-lab investigation of increased high sensitivity troponin I (hsTnl) showed evidence of falsely increased troponin due to the presence of heterophilic antibodies. Discussion: This case demonstrates a complex patient presentation and the value of involving the laboratory medicine team when dealing with potentially discrepant results. This is a rare report of grossly elevated troponin due to heterophilic antibodies for high-sensitivity troponin Abbott assay.