Acute nonrheumatic streptococcal myocarditis resembling ST-elevation acute myocardial infarction in a young patient
Jose L Aguirre1, Margarita Jurado1, Mateo Porres-Aguilar1
1Cardiology Care Consultants, El Paso, Texas (Aguirre, Jurado); the Department of Internal Medicine (Porres-Aguilar), Department of Radiology (Olivas-Chacon), and Division of Cardiovascular Diseases (Mukherjee), Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Texas; the Department of Internal Medicine, Universidad Autonoma de Tamaulipas School of Medicine, Beneficencia Española de Tampico, Tampico, Mexico (Porres-Muñoz); and the Department of Cardiology, Las Palmas Medical Center, El Paso, Texas (Taveras).
Abstract:
Acute myocarditis can be induced by various concomitant disease processes including infections. Most of these cases are viral in origin; however, bacterial infections are also implicated to a lesser degree. Group A streptococcus is a frequent culprit in bacterial-induced myocarditis. Its diagnosis is suspected by the presence of signs and symptoms of rheumatic fever as established by the Jones criteria. The development and refinement of current diagnostic tools has improved our ability to identify specific pathogens. It has been found that group A streptococcus may be responsible for more cases of infection-induced acute myocarditis than previously thought, and often without the clinical features of rheumatic fever. We present the case of a 43-year-old man hospitalized with chest pain that was initially diagnosed as an acute ST-elevation myocardial infarction. Further evaluation confirmed that his chief complaint was due to acute nonrheumatic streptococcal myocarditis.
Insights
Bacterial infections, particularly Group A Streptococcus, can cause acute myocarditis, sometimes without rheumatic fever symptoms. This case highlights streptococcal myocarditis as a potential cause of chest pain mimicking myocardial infarction.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Acute myocarditis is often viral, but bacterial infections are also implicated.
- Group A Streptococcus is a known cause of bacterial myocarditis, typically associated with rheumatic fever.
- Diagnostic advancements improve pathogen identification in myocarditis.
Observation:
- A 43-year-old man presented with chest pain initially diagnosed as ST-elevation myocardial infarction.
- Further investigations revealed the cause to be acute nonrheumatic streptococcal myocarditis.
- This suggests Group A Streptococcus may cause myocarditis more frequently than previously recognized, independent of rheumatic fever.
Findings:
- Group A Streptococcus can induce acute myocarditis without the classic signs of rheumatic fever.
- Streptococcal myocarditis can present with symptoms mimicking acute myocardial infarction.
- Improved diagnostics are crucial for identifying specific bacterial pathogens in myocarditis.
Implications:
- Clinicians should consider streptococcal myocarditis in patients with chest pain, even without rheumatic fever indicators.
- This broadens the differential diagnosis for acute myocarditis and myocardial infarction.
- Further research may uncover a higher prevalence of nonrheumatic streptococcal myocarditis.
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