Acute Myopericarditis Likely Secondary to Disseminated Gonococcal Infection

Area of Science:

• Infectious Diseases
• Cardiology
• Dermatology

Background:

• Disseminated gonococcal infection (DGI), a rare complication of Neisseria gonorrhoeae, infrequently involves the heart, typically as endocarditis.
• Older literature suggests potential direct myocardial involvement in DGI, though this is not commonly recognized.
• Cardiac manifestations of DGI require careful consideration, especially in patients with systemic symptoms.

Purpose of the Study:

• To report a case of disseminated gonococcal infection presenting with acute myocarditis and biventricular dysfunction.
• To emphasize the importance of considering DGI in the differential diagnosis of acute myocarditis, particularly with concurrent mucocutaneous and joint manifestations.
• To illustrate the diagnostic and therapeutic approach to a rare presentation of DGI.

Main Methods:

• Case report of a 38-year-old male with Human Immunodeficiency Virus (HIV).
• Clinical presentation included chest pain, pharyngitis, tenosynovitis, and purpuric skin lesions.
• Diagnostic workup involved transthoracic echocardiogram and skin biopsy; gonococcal infection was not confirmed by culture or nucleic acid amplification testing.

Main Results:

• Transthoracic echocardiogram revealed acute biventricular dysfunction.
• Skin biopsy demonstrated diplococci consistent with disseminated gonococcal infection.
• Treatment with ceftriaxone led to improvement in clinical symptoms and left ventricular ejection fraction.

Conclusions:

• The clinical presentation, histological findings, and response to treatment strongly suggested disseminated gonococcal infection as the cause of acute myocarditis.
• Clinicians should maintain a high index of suspicion for DGI in patients presenting with acute myocarditis, especially when accompanied by skin and joint symptoms.
• This case underscores the potential for Neisseria gonorrhoeae to cause direct myocardial injury beyond endocarditis.