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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