Group A Streptococcal Perimyocarditis Presenting With Acute Left Ventricular Dysfunction

Nonrheumatic group A streptococcal (GAS) perimyocarditis is an uncommon but increasingly recognized clinical entity.

We describe a 41-year-old man who presented with acute chest pain shortly after recent GAS pharyngitis. Electrocardiography demonstrated diffuse ST-segment elevation, inflammatory markers were elevated, and transthoracic echocardiography revealed new left ventricular systolic dysfunction despite nonobstructive coronary anatomy on coronary angiography. The patient was treated with antibiotics, ibuprofen, colchicine, and guideline-directed medical therapy. Follow-up cardiac magnetic resonance demonstrated a nonischemic myocardial injury pattern compatible with prior myocarditis as well as recovery of left ventricular systolic function.

Nonrheumatic GAS-associated perimyocarditis is a rare inflammatory cardiac complication of streptococcal pharyngitis that may present with chest pain, myocardial injury, and left ventricular dysfunction.

GAS-associated perimyocarditis should be considered in patients presenting with acute chest pain and left ventricular dysfunction shortly after streptococcal pharyngitis. Recognition of this syndrome is important to guide appropriate diagnostic evaluation, including exclusion of obstructive coronary disease and utilization of multimodality imaging.