Ragesh Panikkath1, Vanessa Costilla2, Priscilla Hoang3, Joseph Wood4, James F Gruden5, Bob Dietrich4, Michael B Gotway5, Christopher Appleton3. 1. Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas. 2. Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona. 3. Division of Cardiology, Mayo Clinic, Scottsdale, Arizona. 4. Department of Emergency Medicine, Mayo Clinic, Scottsdale, Arizona. 5. Department of Radiology, Mayo Clinic, Scottsdale, Arizona.
Abstract
BACKGROUND: Diarrhea and chest pain are common symptoms in patients presenting to the emergency department (ED). However, rarely is a relationship between these two symptoms established in a single patient. OBJECTIVE: Describe a case of Campylobacter-associated myocarditis. CASE REPORT: A 43-year-old man with a history of hypertension presented to the ED with angina-like chest pain and a 3-day history of diarrhea. Electrocardiogram revealed ST-segment elevation in the lateral leads. Coronary angiogram revealed no obstructive coronary artery disease. Troponin T rose to 1.75 ng/mL. Cardiac magnetic resonance imaging showed subepicardial and mid-myocardial enhancement, particularly in the anterolateral wall and interventricular septum, consistent with a diagnosis of myocarditis. Stool studies were positive for Campylobacter jejuni. CONCLUSIONS: Campylobacter-associated myocarditis is rare, but performing the appropriate initial diagnostic testing, including stool cultures, is critical to making the diagnosis. Identifying the etiology of myocarditis as bacterial will ensure that appropriate treatment with antibiotics occurs in addition to any cardiology medications needed for supportive care.
BACKGROUND:Diarrhea and chest pain are common symptoms in patients presenting to the emergency department (ED). However, rarely is a relationship between these two symptoms established in a single patient. OBJECTIVE: Describe a case of Campylobacter-associated myocarditis. CASE REPORT: A 43-year-old man with a history of hypertension presented to the ED with angina-like chest pain and a 3-day history of diarrhea. Electrocardiogram revealed ST-segment elevation in the lateral leads. Coronary angiogram revealed no obstructive coronary artery disease. Troponin T rose to 1.75 ng/mL. Cardiac magnetic resonance imaging showed subepicardial and mid-myocardial enhancement, particularly in the anterolateral wall and interventricular septum, consistent with a diagnosis of myocarditis. Stool studies were positive for Campylobacter jejuni. CONCLUSIONS:Campylobacter-associated myocarditis is rare, but performing the appropriate initial diagnostic testing, including stool cultures, is critical to making the diagnosis. Identifying the etiology of myocarditis as bacterial will ensure that appropriate treatment with antibiotics occurs in addition to any cardiology medications needed for supportive care.