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Myocarditis related to Campylobacter jejuni infection: a case report
Christy Cunningham1, Christine H Lee
1Department of Pathology and Molecular Medicine, McMaster University, St Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. christy.cunningham@learnlink.mcmaster.ca
Background:
Myocarditis can develop as a complication of various infections and is most commonly linked to enterovirus infections. Myocarditis is rarely associated with bacterial infections; salmonellosis and shigellosis have been the most frequently reported bacterial cause. We report a case of myocarditis related to Campylobacter jejuni enteritis.
Case Presentation:
A 30-year-old previously healthy man presented with a history of prolonged chest pain radiating to the jaw and the left arm. Five days prior to the onset of chest pain, he developed bloody diarrhea, fever and chills. Creatine kinase (CK) and CK-MB were elevated to 289 U/L and 28.7 microg/L. Troponin I was 30.2 microg/L. The electrocardiogram (ECG) showed T wave inversion in the lateral and inferior leads. The chest pain resolved within 24 hours of admission. The patient had a completely normal ECG stress test. The patient was initiated on ciprofloxacin 500 mg po bid when Campylobacter jejuni was isolated from the stool. Diarrhea resolved within 48 hours of initiation of ciprofloxacin. The diagnosis of Campylobacter enteritis and related myocarditis was made based on the clinical and laboratory results and the patient was discharged from the hospital in stable condition.
Conclusion:
Myocarditis can be a rare but severe complication of infectious disease and should be considered as a diagnosis in patients presenting with chest pain and elevated cardiac enzymes in the absence of underlying coronary disease. It can lead to cardiomyopathy and congestive heart failure. There are only a few reported cases of myocarditis associated with Campylobacter infection.
Insights
This case report highlights a rare instance of myocarditis, an inflammation of the heart muscle, linked to Campylobacter jejuni enteritis. Prompt diagnosis and antibiotic treatment led to the patient's recovery.
Area of Science:
- Infectious Diseases
- Cardiology
- Gastroenterology
Background:
- Myocarditis is typically associated with viral infections, rarely with bacterial pathogens.
- Bacterial causes of myocarditis are infrequently reported, with Salmonella and Shigella being most common.
- Campylobacter jejuni enteritis is an uncommon cause of myocarditis.
Observation:
- A previously healthy 30-year-old male presented with chest pain, fever, and bloody diarrhea.
- Elevated cardiac enzymes (CK, CK-MB, Troponin I) and ECG changes indicated myocardial injury.
- Campylobacter jejuni was identified in stool samples.
Findings:
- The patient was diagnosed with Campylobacter enteritis and associated myocarditis.
- Treatment with ciprofloxacin resolved the enteritis symptoms.
- The patient's chest pain and cardiac markers improved, with a normal ECG stress test.
Implications:
- Myocarditis is a rare but serious complication of infectious diseases.
- Consider myocarditis in patients with chest pain and elevated cardiac enzymes, especially with recent infections.
- Early diagnosis and treatment are crucial to prevent complications like cardiomyopathy and heart failure.