Myocarditis presenting as gastritis in children

Area of Science:

• Pediatric Cardiology
• Pediatric Emergency Medicine
• Infectious Diseases

Background:

• Abdominal pain and vomiting are frequent reasons for pediatric emergency department visits.
• The differential diagnosis for pediatric abdominal pain is broad, often including gastrointestinal etiologies.
• Acute myocarditis, inflammation of the heart muscle, can present with diverse and sometimes atypical symptoms.

Observation:

• Two pediatric cases are presented who initially exhibited symptoms of abdominal pain, vomiting, and loose stools.
• On presentation, both children were hypotensive with tachycardia and cyanotic extremities.
• Diagnostic findings included elevated serum troponin-I levels and echocardiographic evidence of poor left ventricular function.

Findings:

• Both patients rapidly deteriorated, developing arrhythmias and coma within hours of arrival.
• Despite initial presentation mimicking gastrointestinal illness, the underlying cause was identified as acute myocarditis.
• The cases highlight the potentially fatal course of myocarditis when presenting with gastrointestinal symptoms.

Implications:

• Abdominal pain and vomiting in children can be a critical, yet overlooked, manifestation of acute myocarditis.
• Emergency physicians should consider myocarditis in the differential diagnosis for children with unexplained hypotension or refractory symptoms.
• Early recognition and diagnosis of pediatric myocarditis are crucial for timely intervention and potentially improving outcomes.