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Myocarditis Following Invasive Group A Streptococcus Infection: Important Differential Diagnostic Distinctions

Jonathan M Oxman1, Michael Bourne1, David C Perlman1

  • 1Department of Medicine, Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, 440 West 114, , Street, New York, 10025, New York State, USA, mountsinai.org.

Case Reports in Infectious Diseases
|April 9, 2026
PubMed

Insights

Nonrheumatic streptococcal pharyngitis-associated myocarditis and acute rheumatic fever are distinct conditions following Group A Streptococcus infection. Differentiating these entities is crucial for appropriate patient management and understanding long-term outcomes.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Rheumatology

Background:

  • Group A Streptococcus (GAS) pharyngitis can lead to distinct cardiac complications.
  • Nonrheumatic streptococcal pharyngitis-associated myocarditis (NRSAM) is an acute, toxin-mediated condition.
  • Acute rheumatic fever (ARF) is a delayed autoimmune sequela of GAS infection, potentially causing rheumatic heart disease.

Purpose of the Study:

  • To differentiate between NRSAM and ARF in a clinical case.
  • To highlight the diagnostic challenges and need for further research into these GAS-related cardiac conditions.

Main Methods:

  • Case report of a 21-year-old male with invasive GAS infection and carditis.
  • Clinical presentation, diagnostic considerations, and management of mitral regurgitation and heart failure were analyzed.

Main Results:

  • The patient developed carditis with heart failure following GAS infection.
  • Both NRSAM and ARF with carditis were considered in the differential diagnosis.
  • The case underscores the importance of distinguishing between these two distinct pathophysiological processes.

Conclusions:

  • Accurate clinical differentiation between NRSAM and ARF is essential.
  • Further epidemiological and clinical studies are needed to better understand and manage these streptococcal-associated cardiac conditions.
Keywords:
Group A StreptococcusSPAMStreptococcus pyogenesacute rheumatic fevernonrheumatic streptococcal pharyngitis−associated myocarditis

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