https://doi.org/10.4081/ecj.2023.11606
When infection strikes the heart: identifying and treating non-rheumatic streptococcal myocarditis in a young man with chest pain and concurrent streptococcal pharyngitis
Submitted: 23 July 2023
Accepted: 1 September 2023
Published: 8 September 2023
Accepted: 1 September 2023
Abstract Views: 1369
PDF: 365
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Pharyngitis and tonsillitis are common reasons for seeking medical care. While mostly viral, Streptococcus pyogenescauses 5-20% of adult cases. Non-rheumatic streptococcal myocarditis is a distinct form of myocarditis associated with streptococcal infection and has clinical features resembling acute coronary syndrome. It mainly affects young men and can lead to significant complications, including sudden cardiac death. We present a case of a young man with non-rheumatic streptococcal myocarditis that developed three days after streptococcal pharyngitis. This is the first documented case in which a treatment approach using a combination of benzathine phenoxymethylpenicillin, perindopril, and bisoprolol, followed by extended therapy with extencillin, resulted in a rapid improvement in the patient's cardiac function and general health. The insights gained from this case offer valuable guidance for managing similar conditions in the future.
Schmutzler L, Mirna M, Hoppe UC, Lichtenauer M. From streptococcal pharyngitis/tonsillitis to myocarditis: a systematic review. J Cardiovasc Dev Dis 2022;9:170.
DOI: https://doi.org/10.3390/jcdd9060170
Tschöpe C, Ammirati E, Bozkurt B, et al. Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol 2021;18:169-93.
DOI: https://doi.org/10.1038/s41569-020-00435-x
Lampejo T, Durkin SM, Bhatt N, Guttmann O. Acute myocarditis: aetiology, diagnosis and management. Clin Med (Lond) 2021;21:505-10.
DOI: https://doi.org/10.7861/clinmed.2021-0121
Zühlke LJ, Beaton A, Engel ME, et al. Group A streptococcus, acute rheumatic fever and rheumatic heart disease: epidemiology and clinical considerations. Curr Treat Options Cardiovasc Med 2017;19:15.
DOI: https://doi.org/10.1007/s11936-017-0513-y
Talmon Y, Gilbey P, Fridman N, et al. Acute myopericarditis complicating acute tonsillitis: beware the young male patient with tonsillitis complaining of chest pain. Ann Otol Rhinol Laryngol 2008;117:295-7.
DOI: https://doi.org/10.1177/000348940811700409
Aguirre JL, Jurado M, Porres-Aguilar M, et al. Acute nonrheumatic streptococcal myocarditis resembling ST-elevation acute myocardial infarction in a young patient. Proc (Bayl Univ Med Cent) 2015;28:188-90.
DOI: https://doi.org/10.1080/08998280.2015.11929224
Hiraiwa H, Morimoto R, Ando R, et al. Recurrent fulminant non-rheumatic streptococcal myocarditis proven by endomyocardial biopsy and autopsy. J Cardiol Cases 2022;26:62-5.
DOI: https://doi.org/10.1016/j.jccase.2022.02.004
Allen J, Munoz C, Byakova A, Pachulski R. Acute fulminant group A beta-hemolytic streptococcus-associated carditis: a case report and literature review. Cureus 2022;14:e27282.
DOI: https://doi.org/10.7759/cureus.27282
Kalpakos T, Wilgenhof A, Michiels V, et al. Streptococcal pharyngitis associated myocarditis (SPAM): the perfect ST-segment elevation myocardial infarction (STEMI) mimic in young individuals. A case series. Acta Cardiol 2021;76:449-54.
DOI: https://doi.org/10.1080/00015385.2020.1854985
Fox-Lewis A, Merz TM, Hennessy I. Severe non-rheumatic streptococcal myocarditis requiring extracorporeal membrane oxygenation support. Lancet Infect Dis 2020;20:1481.
DOI: https://doi.org/10.1016/S1473-3099(20)30689-7
Ferrero P, Piazza I, Lorini LF, Senni M. Epidemiologic and clinical profiles of bacterial myocarditis. Report of two cases and data from a pooled analysis. Indian Heart J 2020;72:82-92.
DOI: https://doi.org/10.1016/j.ihj.2020.04.005
Derbas LA, Samanta A, Potla S, et al. Separating acute rheumatic fever from nonrheumatic streptococcal myocarditis. Case Rep Med 2019:4674875.
DOI: https://doi.org/10.1155/2019/4674875
Müller C. 31-year old male with fever, chest pain and tonsillitis. Dtsch Med Wochenschr 2019;144:201-2.
DOI: https://doi.org/10.1055/a-0480-8005
O’Brien CE, Coulson JD, Sekar P, et al. Non-rheumatic streptococcal myocarditis mimicking acute myocardial infarction in an adolescent male. Cardiol Young 2018;28:454-7.
DOI: https://doi.org/10.1017/S1047951117001524
Silva R, Puga L, Teixeira R, et al. Acute non-rheumatic myopericarditis: a rare complication of pharyngitis. Eur J Case Rep Intern Med 2018;5:000987.
DOI: https://doi.org/10.12890/2018_000987
Al-Jazairi A, Al-Jaser R, Al-Halees Z, et al. Guidelines for the secondary prevention of rheumatic heart disease: endorsed by Saudi Pediatric Infectious Diseases Society (SPIDS). Int J Pediatr Adolesc Med 2017;4:47-50.
DOI: https://doi.org/10.1016/j.ijpam.2017.02.002
Talmon Y, Ishai R, Samet A, et al. Acute myopericarditis complicating acute tonsillitis: a prospective study. Ann Otol Rhinol Laryngol 2009;118:556-8.
DOI: https://doi.org/10.1177/000348940911800804
Liew JW, Ramiro S, Gensler LS. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis. Best Pract Res Clin Rheumatol 2018;32:369-89.
DOI: https://doi.org/10.1016/j.berh.2019.01.002
Silverblatt JA, Ziff OJ, Dancy L, et al. Therapies to limit myocardial injury in animal models of myocarditis: a systematic review and meta-analysis. Basic Res Cardiol 2019;114:48.
DOI: https://doi.org/10.1007/s00395-019-0754-x
Mustafa Z, Ghaffari M. Diagnostic methods, clinical guidelines, and antibiotic treatment for group A streptococcal pharyngitis: a narrative review. Front Cell Infect Microbiol 2020;10:563627.
DOI: https://doi.org/10.3389/fcimb.2020.563627
How to Cite
Mihevc, M. (2023). When infection strikes the heart: identifying and treating non-rheumatic streptococcal myocarditis in a young man with chest pain and concurrent streptococcal pharyngitis. Emergency Care Journal, 19(3). https://doi.org/10.4081/ecj.2023.11606
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
