title: Recurrent Acute Nonrheumatic Streptococcal Myocarditis Mimicking STEMI in a Young Adult.
abstract: Myocarditis consists of an inflammation of the cardiac muscle, definitively diagnosed by endomyocardial biopsy. The causal agents are primarily infectious: in developed countries, viruses appear to be the main cause, whereas in developing countries rheumatic carditis, Chagas disease, and HIV are frequent causes. Furthermore, myocarditis can be indirectly induced by an infectious agent and occurs following a latency period during which antibodies are created. Typically, myocarditis observed in rheumatic fever related to group A streptococcal (GAS) infection occurs after 2- to 3-week period of latency. In other instances, myocarditis can occur within few days following a streptococcal infection; thus, it does not fit the criteria for rheumatic fever. Myocarditis classically presents as acute heart failure, and can also be manifested by tachyarrhythmia or chest pain. Likewise, GAS-related myocarditis reportedly mimics myocardial infarction (MI) with typical chest pain, electrocardiograph changes, and troponin elevation. Here we describe a case of recurrent myocarditis, 5 years apart, with clinical presentation imitating an acute MI in an otherwise healthy 37-year-old man. Both episodes occurred 3 days after GAS pharyngitis and resolved quickly following medical treatment.
authors: Department of Internal Medicine, Hebrew University, Hadassah Ein Kerem Medical Center, P.O. Box 12000, 91120 Jerusalem, Israel.
authors: Amanda
authors: 0000-0002-1920-8990
authors: A
authors: Chikly
authors: Department of Cardiology, Hebrew University, Hadassah Ein Kerem Medical Center, P.O. Box 12000, 91120 Jerusalem, Israel.
authors: Ronen
authors: 0000-0003-3559-1050
authors: R
authors: Durst
authors: Department of Cardiology, Hebrew University, Hadassah Ein Kerem Medical Center, P.O. Box 12000, 91120 Jerusalem, Israel.
authors: Chaim
authors: 0000-0002-2738-074X
authors: C
authors: Lotan
authors: Department of Cardiology, Hebrew University, Hadassah Ein Kerem Medical Center, P.O. Box 12000, 91120 Jerusalem, Israel.
authors: Shmuel
authors: 0000-0001-8843-1777
authors: S
authors: Chen