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Streptococcal Pharyngitis Complicated by Clinically Significant Rheumatic Myopericarditis: A Case Report
Amanda Nguyen1, Garrett Cohen2, Matthew Lam3
1Department of Medicine, University of California Davis Medical Center, Sacramento, USA.
Summary
Acute rheumatic fever (ARF) can cause heart inflammation, even in adults. Early diagnosis and antibiotic treatment are crucial for preventing severe cardiac complications and ensuring recovery.
Area of Science:
- Cardiology
- Infectious Diseases
- Rheumatology
Background:
- Acute rheumatic fever (ARF) is a sequela of streptococcal pharyngitis.
- Cardiac involvement, including myocarditis and pericarditis, can occur in ARF.
- While ARF prevalence has decreased, sporadic cases and outbreaks persist.
Purpose of the Study:
- To report a case of rheumatic myopericarditis in an adult patient.
- To highlight the importance of considering ARF in patients with cardiac symptoms following pharyngitis.
- To emphasize the role of timely diagnosis and management in ARF-related cardiac complications.
Main Methods:
- Case report of a 60-year-old male presenting with pharyngitis and subsequent cardiac symptoms.
- Diagnostic workup included laboratory tests (inflammatory markers, cardiac enzymes, ASO titers), electrocardiogram, echocardiogram, and blood cultures.
- Management involved pericardial drainage, medical therapy for heart failure and pericarditis, and antibiotic treatment for ARF.
Main Results:
- The patient presented with sore throat, later developing chest pain and dyspnea.
- Laboratory findings revealed elevated inflammatory markers, cardiac enzymes, positive ASO titers, and Streptococcus pyogenes bacteremia.
- Diagnosis of rheumatic myopericarditis was confirmed, with pericarditis, effusion, and reduced systolic function.
- The patient recovered cardiac function following treatment.
Conclusions:
- Rheumatic myopericarditis is a rare but serious complication of streptococcal pharyngitis that can affect adults.
- Clinicians should maintain a high index of suspicion for ARF in patients with cardiac manifestations, even without a history of rheumatic heart disease.
- Prompt diagnosis, appropriate antibiotic therapy, and management of cardiac involvement are essential for favorable outcomes in ARF.
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