Cocaine abuse can cause degenerative and inflammatory alterations of the myocardium. Cocaine-induced myocarditis has been previously described, but mostly in chronic cocaine addicts. Among several pathogenetic mechanisms of cocaine-related myocardial damage, the myocardial adrenergic stress and cardiomyocytes apoptosis have been recently proposed. We report an unusual case of myocarditis involving the bundle of His and left bundle branch and cardiac myocytes apoptosis in otherwise healthy occasional cocaine abuser.