Brief observationAcute Nonrheumatic Streptococcal Myocarditis: STEMI Mimic in Young Adults
Section snippets
Materials and Methods
We retrospectively reviewed all cases of acute nonrheumatic streptococcal myocarditis over a 17-year period (January 1994 to December 2010). Patients were identified using a hospital-wide database containing admission, discharge, and associated diagnoses. Search terms included any combination of tonsillitis, acute tonsillitis, infective tonsillitis, peritonsillitis, pharyngotonsillitis, suppurative tonsillitis, streptococcal tonsillitis, streptococcal sore throat, group A streptococcal
Results
Nine patients with acute nonrheumatic streptococcal myocarditis were identified; 89% were male, and the average age was 28.6 years. No patients had a history of cardiovascular disease or rheumatic fever. Key clinical characteristics are presented in Table 1 with a summary in Table 2. The majority of patients (78%) had streptococcal pharyngitis confirmed via microbiologic testing at Massachusetts General Hospital; microbiologic assay results were not available for review in 2 patients who were
Discussion
We present the largest single-center case series of acute nonrheumatic streptococcal myocarditis in the United States. Acute nonrheumatic streptococcal myocarditis mimics acute coronary syndrome on presentation and should be considered in the differential of young persons presenting with chest pain. Hallmark features include a history of pharyngitis, ST-segment elevations on electrocardiogram, and an average latency period of 3 days after throat symptoms. Previous reports have suggested the
Conclusions
Acute nonrheumatic streptococcal myocarditis should be considered in the differential diagnosis of young patients presenting with ST-segment elevations, chest pain, and a history of sore throat. Rapid antigen testing is sufficient for diagnosing streptococcal infection, and absence of anti-streptolysin O and anti-DNAse B elevation confirms acuity. CMR imaging may be used to assess disease severity and document resolution. Of note, unlike many forms of viral myocarditis, acute nonrheumatic
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Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.
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Drs Upadhyay and Gainor contributed equally to the investigation.