title: A Rare Case of Toxic Myocarditis Caused by Bacterial Liver Abscess Mimicking Acute Myocardial Infarction.
abstract: BACKGROUND
  Chills, high fever, right upper abdomen pain, and increased white blood cell count are the main and common clinical features of bacterial liver abscess. It is rare to see bacterial liver abscess present symptoms of myocardial injury first, and this can lead to misdiagnosis.
  
  
  METHODS
  We report a case of toxic myocarditis caused by bacterial liver abscess. The patient first presented with chest pain, ST segment elevation, and elevated TNI, which misled us to diagnose myocardial infarction, but the coronary artery had no stenosis or obstructive lesions after emergency coronary angiography. Then we modified the diagnosis to toxic myocarditis. Bacterial liver abscess was the proposed etiology after a series of auxiliary examinations. Finally, antibiotics and percutaneous liver puncture catheter drainage were used to improve the clinical outcome.
  
  
  CONCLUSIONS
  It is rare that patients with bacterial liver abscess first present symptoms of myocardial injury. Differential diagnosis between myocarditis and myocardial infarction should be careful, as myocarditis is a diagnosis of exclusion, and coronary angiography is necessary to confirm coronary disease. Percutaneous liver puncture catheter drainage can effectively cure bacterial liver abscess.
authors.affiliation: Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China (mainland).
authors.forename: Yuhai
authors.initials: Y
authors.lastname: Zou
authors.affiliation: Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China (mainland).
authors.forename: Lin
authors.initials: L
authors.lastname: Lin
authors.affiliation: Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China (mainland).
authors.forename: Hua
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China (mainland).
authors.forename: Dingcheng
authors.initials: D
authors.lastname: Xiang
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008100:Liver Abscess / Q000382:microbiology*; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis; D009205:Myocarditis / Q000382:microbiology*