From gastroenteritis to myocarditis: a case series of Campylobacter-mediated cardiac involvement

While viruses remain the leading cause of infectious myocarditis, improved diagnostic methods have highlighted the role of bacteria as a possible cause. We report two cases of myocarditis as a complication of Campylobacter jejuni infection.

Patient A, a 17-year-old Caucasian male with a history of asthma, presented to the emergency department (ED) after experiencing fever and nausea for four days, followed by 1 day of diarrhoea and chest discomfort. Laboratory evaluation revealed elevated troponin levels. Transthoracic echocardiography showed left ventricular enlargement and apical dyskinesia. C. jejuni was identified in stool cultures. Cardiac magnetic resonance imaging confirmed the diagnosis of myocarditis. The patient was treated with furosemide and enalapril, with improvement of symptoms. Patient B, a previously healthy 14-year-old Caucasian male, presented to the ED with retrosternal chest pain lasting 2 h. He also reported a 3-day history of fever, nausea, and diarrhoea. Electrocardiography showed widespread PR-segment depression and concave ST-segment elevation. Laboratory testing revealed elevated Troponin I levels, and C. jejuni was identified in stool cultures. Cardiac magnetic resonance imaging findings were consistent with acute myocarditis. The patient was treated with ibuprofen and azithromycin, leading to resolution of symptoms. Eight months later, he returned with recurrent chest pain and dry cough. Cardiac magnetic resonance imaging at this time showed T1 and T2 criteria consistent with recurrent myocarditis.

Although rare, clinicians should be aware of the potential cardiac involvement in patients with Campylobacter gastroenteritis, paying special attention to myocarditis symptoms like chest pain or shortness of breath, especially in areas with elevated Campylobacter infection rates.