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Trichinella spiralis-associated myocarditis mimicking acute myocardial infarction
Othmane Mohib1, Philippe Clevenbergh2, Carine Truyens3
1Internal Medicine Department, Brugmann University Hospital, Brussels, Belgium.
Background:
Trichinellosis is a parasitic infection caused by nematodes of the genus Trichinella, and its principal mode of transmission is the consumption of raw or undercooked contaminated meat. Cardiac involvement in trichinellosis is unusual, yet it represents the most frequent cause of death. Here, we report a case in which Trichinella spiralis-associated myocarditis simulated a myocardial infarction.
Case Presentation:
A 35-year-old African man with no previous medical history was admitted to the emergency department for acute substernal discomfort at rest described as a pressure with no radiation. The electrocardiogram performed upon admission showed non-specific alterations of repolarization. Blood biology revealed high levels of troponin T and predominant eosinophilic leukocytosis. A transthoracic echocardiography was carried out and found a significant left ventricular concentric hypertrophy with a preserved ejection fraction. The septal and inferior walls, as well as the endocardium were hyperechogenic. The patient was hospitalized for eosinophilic myocarditis. The cause of hypereosinophilia was investigated, and a Trichinella spiralis serology came back strongly positive. A diagnosis of Trichinella spiralis associated-myocarditis was made.The patient was treated with albendazole-prednisolone dual therapy with favorable clinical and biological outcomes.
Conclusion:
The clinical suspicion of trichinellosis is based on suggestive epidemiology associated with the typical clinical presentation and the presence of eosinophilia. Eosinophilic myocarditis is a severe complication of trichinellosis which can result in death due to rhythm disorders. Chest pain, increase in troponins, and electrocardiographic abnormalities are all elements that can mimic a myocardial infarction and mislead clinicians.Abbreviations: ANCA: Anti-Neutrophil Cytoplasmic Antibodies; ANA: Anti-Nuclear Antibodies; ECDC: European Centre for Disease Prevention and Control; ECG: Electrocardiogram; ELISA: Enzyme-Linked ImmunoSorbent Assay; EMF: Endomyocardial Fibrosis; ES: Excretory-Secretory; ICT: International Commission on Trichinellosis; MRI: Magnetic Resonance Imaging.
Insights
Trichinellosis, a parasitic infection, can cause eosinophilic myocarditis that mimics a heart attack. Early diagnosis and treatment with antiparasitic and anti-inflammatory drugs are crucial for favorable outcomes in this rare cardiac complication.
Area of Science:
- Infectious Diseases
- Cardiology
- Parasitology
Background:
- Trichinellosis is a parasitic zoonosis transmitted via undercooked meat, caused by Trichinella nematodes.
- Cardiac involvement, though uncommon, is a severe complication of trichinellosis, often leading to mortality.
- This case highlights Trichinella spiralis-associated myocarditis presenting as myocardial infarction.
Observation:
- A 35-year-old male presented with chest pain, elevated troponin T, and eosinophilic leukocytosis.
- Echocardiography revealed left ventricular hypertrophy and hyperechogenic walls, suggesting myocarditis.
- Positive Trichinella spiralis serology confirmed the parasitic etiology.
Findings:
- The patient was diagnosed with Trichinella spiralis-associated eosinophilic myocarditis.
- Treatment with albendazole and prednisolone resulted in positive clinical and biological responses.
- The condition mimicked myocardial infarction due to chest pain, troponin elevation, and ECG changes.
Implications:
- Clinical suspicion of trichinellosis requires considering epidemiological factors and eosinophilia.
- Eosinophilic myocarditis is a life-threatening complication of trichinellosis, potentially causing fatal arrhythmias.
- Accurate diagnosis is vital to differentiate from myocardial infarction and initiate appropriate antiparasitic therapy.
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