Acute Myopericarditis Complicating Acute Tonsillitis: Beware the Young Male Patient with Tonsillitis Complaining of Chest Pain

Talmon, Yoav; Gilbey, Peter; Fridman, Nancy; Wishniak, Alice; Roguin, Nathan

doi:10.1177/000348940811700409

Cited by 18 publications

(11 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Toxin-mediated myocarditis seems to be the most popular explanation for this condition (Gore & Saphir, 1947;Caraco et al, 1988;Karjalainen, 1989;Gill et al, 1995;Talmon et al, 2008) but needs further investigation. As the streptococcal isolate from case 2 was not available for typing, we typed the organism in case 1 and found it to be 'emm101' -not a known rheumatogenic strain.…”

Section: Discussionmentioning

confidence: 99%

Non-rheumatic streptococcal myocarditis – warm hands, warm heart

Chaudhuri

Dooris

Woods

2013

Journal of Medical Microbiology

View full text Add to dashboard Cite

Acute myopericarditis in the developed world is ascribed predominantly to viral infections. Enteroviruses and adenoviruses are commonly implicated but are not routinely tested for, as the condition is self-limiting and has a good prognosis. However, we recently encountered two cases of acute myopericarditis associated with concomitant Streptococcus pyogenes [group A Streptococcus (GAS)] pharyngotonsillitis. A microbiological aetiology was pursued because of the severity of the upper respiratory tract infection and associated systemic illness rather than to explain the myopericarditis per se. We report these two cases and review the literature of this potentially under-recognized condition. In the absence of features of rheumatic fever, we hypothesize a toxin-mediated process as opposed to an immune-mediated one. We suggest that perhaps all patients with myopericarditis be assessed for GAS pharyngitis. Case reports Case 1A 29-year-old male was brought to our emergency department with left-sided chest pain and high fevers. He had developed a sore throat 3 days prior to admission which progressed to odynophagia and mild trismus at the time of admission. Urgent ENT consultation confirmed a peritonsillar abscess, which was treated with incision and drainage under local anaesthesia. Simultaneous investigation of his chest symptoms revealed widespread 'saddleshaped' ST elevation and a raised serum cardiac troponin I (cTnI) (peak level 25 ng l 21 ). An echocardiogram revealed mild segmental systolic dysfunction and regional wall motion abnormalities (Table 1). The temporal pattern of cTnI levels was not monophasic and the ECG evolution was not typical of myocardial infarction. Coronary artery disease was a possibility, which prompted additional investigations of cardiac magnetic resonance imaging (MRI) and left heart catheterization. MRI showed moderate systolic dysfunction left ventricular ejection fraction 39 % which was segmental but no obstructive coronary artery disease was found on coronary angiogram. Abnormal MRI was consistent with diffuse myopericarditis, with oedema and late gadolinium enhancement in subepicardial and intramural regions (Fig. 1). Left heart catheterization revealed abnormal haemodynamics of relative hypotension with elevated left ventricular enddiastolic pressure. A diagnosis of myopericarditis was made and the patient was admitted with cardiac monitoring.Intravenous penicillin was commenced for peritonsillar abscess, which shortly grew group A Streptococcus (GAS). Streptococcal serology done soon after admission was negative. The patient remained febrile, appeared flushed with warm bounding peripheries but was haemodynamically robust (heart rate of 90-100 b.p.m.; blood pressure of 130/70 mmHg; mean arterial pressure of 90 mmHg). Minimal improvement of his pharyngeal symptoms prompted a repeat incision and drainage, plus the addition of intravenous lincomycin for presumed anaerobic bacterial infections potentially resistant to penicillin. He made a gradual recovery over 5 days and lincomycin w...

show abstract

Section: Discussionmentioning

confidence: 99%

Non-rheumatic streptococcal myocarditis – warm hands, warm heart

Chaudhuri

Dooris

Woods

2013

Journal of Medical Microbiology

View full text Add to dashboard Cite

show abstract

“…Complications of group A β‐haemolytic streptococcal pharyngitis are generally rare in both children and adults (Tables 3 and 4; [7–14]). Potential adverse outcomes include both suppurative (i.e.…”

Section: Bacterial Pathogens In Sore Throatmentioning

confidence: 99%

“…Acute glomerulonephritis is another rare consequence of sore throat, following group A streptococcal pharyngitis after a latency period of a few weeks. Quinsy, a complication that occurs mainly in young adults, is a polymicrobial infection but group A streptococcus is the main organism associated with the disease (Tables 5 and 6; [7–9,11,15–17]).…”

Section: Bacterial Pathogens In Sore Throatmentioning

confidence: 99%

Guideline for the management of acute sore throat

Pelucchi

Grigoryan

Galeone

et al. 2012

Clinical Microbiology and Infection

251

230

View full text Add to dashboard Cite

Clin Microbiol Infect 2012; 18 (Suppl. 1): 1–27 Abstract The European Society for Clinical Microbiology and Infectious Diseases established the Sore Throat Guideline Group to write an updated guideline to diagnose and treat patients with acute sore throat. In diagnosis, Centor clinical scoring system or rapid antigen test can be helpful in targeting antibiotic use. The Centor scoring system can help to identify those patients who have higher likelihood of group A streptococcal infection. In patients with high likelihood of streptococcal infections (e.g. 3–4 Centor criteria) physicians can consider the use of rapid antigen test (RAT). If RAT is performed, throat culture is not necessary after a negative RAT for the diagnosis of group A streptococci. To treat sore throat, either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms. Zinc gluconate is not recommended to be used in sore throat. There is inconsistent evidence of herbal treatments and acupuncture as treatments for sore throat. Antibiotics should not be used in patients with less severe presentation of sore throat, e.g. 0–2 Centor criteria to relieve symptoms. Modest benefits of antibiotics, which have been observed in patients with 3–4 Centor criteria, have to be weighed against side effects, the effect of antibiotics on microbiota, increased antibacterial resistance, medicalisation and costs. The prevention of suppurative complications is not a specific indication for antibiotic therapy in sore throat. If antibiotics are indicated, penicillin V, twice or three times daily for 10 days is recommended. At the present, there is no evidence enough that indicates shorter treatment length.

show abstract

“…The first case of myocarditis unrelated to rheumatic fever was reported in 1947 [ 8 ]. Since then, several other cases, usually describing young patients without a history of cardiac pathologies, have been published, with previously unspecified clinical signs or symptoms and ECG changes in the acute phase of a streptococcal tonsillitis [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Neutropenia and T-Wave Inversion as Toxin-Mediated Complications of a Streptococcal Infection

Popescu

Leuștean

Orfanu

et al. 2017

The Journal of Critical Care Medicine

View full text Add to dashboard Cite

IntroductionStreptococcal infection can be responsible for multiple complications, such as toxic, septic or allergic disorders. Toxin-mediated complications (TMC) can appear during the acute phase of disease and can involve any organ, causing carditis, arthritis, nephritis, hepatitis etc.Case presentationThe case of a young woman without a history of recurrent streptococcal tonsillitis, admitted to “Matei Balş” National Institute for Infectious Diseases, Bucharest, Romania, presenting with fever, sore throat and exudative tonsillitis, is detailed. The initial test for Streptococcus pyogenes was negative. The patient had leukopenia with severe neutropenia, high values of inflammatory biomarkers and electrocardiographic (ECG) changes with inverted T waves in leads V1-4 and flattened T waves in V5-6. There were no other cardiac signs or symptoms. The patient received cefuroxime for two days. On admission, the patient was prescribed Penicillin G and dexamethasone which resulted in a rapid recovery. The leucocytes count returned to normal as did the ECG abnormalities. At the time of discharge, the antistreptolysin O titre was high.ConclusionsThe case highlights the toxin-mediated complications (TMC) of streptococcal infection which occur from the outset of the disease.

show abstract

Acute Myopericarditis Complicating Acute Tonsillitis: Beware the Young Male Patient with Tonsillitis Complaining of Chest Pain

Abstract: Otolaryngologists should be aware of this rare entity. Additional studies are indicated to evaluate the exact incidence of myopericarditis associated with acute streptococcal tonsillitis.

Cited by 18 publications

References 7 publications

Non-rheumatic streptococcal myocarditis – warm hands, warm heart

Non-rheumatic streptococcal myocarditis – warm hands, warm heart

Guideline for the management of acute sore throat

Neutropenia and T-Wave Inversion as Toxin-Mediated Complications of a Streptococcal Infection

Contact Info

Product

Resources

About