A previously healthy 37-year-old man was admitted to our hospital for recurrent syncope. An electrocardiogram showed complete atrioventricular block ( Fig. 1 A ). Medical history, clinical examination, echocardiography, chest X-ray ( Fig. 1 B), coronary arteriography, biological samples (including calcaemia, lyme serology, angiotensin enzyme blood concentration, antineutrophil cytoplasmic antibody and antinuclear antibody tests) were all unremarkable.

A. A rest electrocardiogram demonstrated complete atrioventricular block with a ventricular rate of 40 beats/min. B. A chest X-ray after pacemaker implantation was unremarkable. C, D. Cardiac magnetic resonance imaging showed epicardial delayed enhancement of the anterior wall and the inferoseptal wall. E, F. A computed tomography scan showed micronodular pulmonary infiltration and spleen nodular hypodense lesions.

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