Acute streptococcal myopericarditis mimicking myocardial infarction.
A 25-year-old man who had recurrent sore throats presented with sharp central chest pain 5 hours after starting penicillin for tonsillitis. Electrocardiogram (ECG) revealed ST-segment elevation in leads I and aVL with reciprocal ST depression in lead III (Fig. 1). Troponin I was measured as 33 microg/L (normal range, b0.1 microg/L), and C-reactive protein (CRP) was 127 (normal range b10). Echocardiogram revealed a nondilated well-contracting left ventricle, and cardiac catheterization revealed normal coronary arteries. A diagnosis of acute myopericarditis was made, and he was treated with moxifloxacin. Throat swabs grew Lancefield group A Streptococcus. Over subsequent days, his symptoms and ECG changes resolved, and he was discharged on longterm prophylactic penicillin.
Department of Cardiology, Southmead Hospital, BS10 5NB Bristol, United Kingdom. khavandi@hotmail.com
Ali
A
Khavandi
John
J
Whitaker
Andrew
A
Elkington
Jo
J
Probert
Paul R
PR
Walker
D000328:Adult; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D009220:Myositis / Q000175:diagnosis* / Q000382:microbiology; D010493:Pericarditis / Q000175:diagnosis* / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology