Acute nonrheumatic streptococcal myocarditis: STEMI mimic in young adults.

[acute rheumatic fever]

Mimicking ST-segment elevation myocardial infarction upon presentation , acute nonrheumatic streptococcal myocarditis is a treatable etiology of myocarditis which has only been infrequently reported .Patients were identified through a retrospective query of electronic medical records over a 17 -year period (January 1994 to December 2010 ). We describe a case series of acute nonrheumatic streptococcal myocarditis complicating pharyngitis in young adults .Nine patients were identified ; 89 % were male , patients had an average age of 28 .6 years , and 56 % and 22 % had confirmed group A and group G streptococcus , respectively . Latency from pharyngitis to chest pain averaged 3 .1 ±1 .1 days . No patients met the revised Jones criteria for acute rheumatic fever . All 9 patients (100 %) presented with ST-segment elevations on electrocardiography and elevated cardiac biomarkers . Average peak creatine kinase was 934 U /L (normal <400 U /L ), creatine kinase-MB was 82 ng /mL (normal <6 .9 ng /mL ), and troponin T was 2 .30 ng /mL (normal <0 .03 ng /mL ). Six patients underwent coronary angiography , which revealed no obstructive culprit lesions . Cardiac magnetic resonance imaging confirmed myocarditis in 3 patients and was used to document resolution in follow-up for 2 patients . All patients had a complete clinical recovery .Acute nonrheumatic streptococcal myocarditis is an under-recognized and treatable cause of ST-segment elevation and chest pain in young adults with a history of recent pharyngitis . Etiopathology extends beyond Lancefield group A streptococcus and includes group G streptococcal infection . Cardiac magnetic resonance may be useful in confirming the diagnosis and documenting the resolution .

Diseases
Validation

Diseases presenting "fever" symptom

22q11.2 deletion syndrome

acute rheumatic fever

alexander disease

allergic bronchopulmonary aspergillosis

canavan disease

carcinoma of the gallbladder

child syndrome

congenital toxoplasmosis

cushing syndrome

cystinuria

dracunculiasis

erdheim-chester disease

esophageal adenocarcinoma

esophageal carcinoma

familial mediterranean fever

focal myositis

hodgkin lymphoma, classical

lamellar ichthyosis

legionellosis

locked-in syndrome

malignant atrophic papulosis

neonatal adrenoleukodystrophy

neuralgic amyotrophy

oculocutaneous albinism

papillon-lefèvre syndrome

pyomyositis

pyruvate dehydrogenase deficiency

scrub typhus

severe combined immunodeficiency

sneddon syndrome

systemic capillary leak syndrome

triple a syndrome

typhoid

waldenström macroglobulinemia

wolf-hirschhorn syndrome

This symptom has already been validated