Separating Acute Rheumatic Fever from Nonrheumatic Streptococcal Myocarditis

Case Reports in Medicine
Laith A DerbasIbrahim M Saeed

Abstract

Streptococcal pharyngitis has been historically complicated with systemic involvement manifesting as acute rheumatic fever, which is a serious condition that can lead to permanent damage to heart valves. A recent association between streptococcal pharyngitis and nonrheumatic heart disease is emerging in literature. We present a case of nonrheumatic streptococcal myocarditis diagnosed using cardiac MRI. A 25-year-old male, presented with complaints of sore throat, nonproductive cough, fever, pleuritic chest pain, and progressive dyspnea for four days. The patient had elevated troponins at presentation of 0.47 (ng/L) that peaked at 4.0 (ng/L). ECG showed sinus rhythm and ST elevations in leads V2, V3, V4, and V5. NT-Pro-BNP was 1740. Transthoracic echocardiogram (TTE) showed reduced ejection fraction (EF) of 37% and global hypokinesis. The rapid strep test was positive for group A streptococcus and C-reactive protein was elevated at 161. Cardiac MRI demonstrated an EF of 53% and edema in the anterior wall without delayed gadolinium enhancement. Cardiac catheterization showed normal coronaries. According to modified Jones criteria, the patient did not meet the full major or minor criteria to be diagnosed with acute rheumatic fever...Continue Reading

References

Sep 1, 1995·Heart & Lung : the Journal of Critical Care·M V GillB A Cunha
May 16, 2008·The Annals of Otology, Rhinology, and Laryngology·Yoav TalmonNathan Roguin
Jan 1, 2009·Annals of Pediatric Cardiology·S Ramakrishnan
Jul 7, 2010·European Journal of Internal Medicine·Stephen D H MalnickRon Unger
Aug 14, 2010·JACC. Cardiovascular Imaging·Rasoul MokabberiWilliam Schiavone
Sep 25, 2012·Journal of Medical Microbiology·Alex ChaudhuriMarion L Woods
Apr 25, 2015·Circulation·Michael H GewitzUNKNOWN American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular
Sep 10, 2017·European Heart Journal·Helmut BaumgartnerUNKNOWN ESC Scientific Document Group

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Citations

Sep 17, 2020·Clinical Medicine : Journal of the Royal College of Physicians of London·John SerelisHaralampos M Moutsopoulos
Aug 8, 2020·Zeitschrift für Rheumatologie·H Zeidler

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