Streptococcal Tonsillitis and Acute Streptococcal Myocarditis: An Unusual Combination Assessed by Cardiac Magnetic Resonance Imaging and Endomyocardial Biopsy

Mavrogeni, Sophie; Bratis, Konstantinos; Kitsiou, Anastasia; Kolovou, Genovefa

doi:10.1177/000348941212100907

Cited by 10 publications

(6 citation statements)

References 13 publications

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“…Moreover, one patient had an alternating second-/third-degree atrioventricular block, and in one case, there was a non-sustained ventricular tachycardia. Cardiac enzymes were, if applicable, almost always elevated, except in the study by Mavrogeni et al (2012) [ 10 ], where 9 out of 17 patients did not have elevated cardiac biomarkers, and in the study by Caraco et al, (1988) [ 32 ], in which one female had normal creatinine kinase values.…”

Section: Resultsmentioning

confidence: 99%

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From Streptococcal Pharyngitis/Tonsillitis to Myocarditis: A Systematic Review

Schmutzler

Mirna

Hoppe

et al. 2022

JCDD

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(1) Background: Myocarditis following group A streptococcal pharyngitis and tonsillitis is a relatively rare medical condition. The aim of this systematic review was to identify specific ECG changes, laboratory parameters and signs, and symptoms associated with this disease. (2) Methods: A systematic literature review was performed in concordance with the current PRISMA guidelines, including the databases PubMed/MEDLINE, Web of Science, CDSR, CENTRAL, CCAs, EBM Reviews, and LILACS. Articles were included if they covered myocarditis after streptococcal pharyngitis/tonsillitis in humans. Exclusion criteria were rheumatic, autoimmune, or toxic myocarditis. (3) Results: Patients that developed myocarditis after group A streptococcal throat infection frequently presented with chest pain, elevated cardiac markers, and ST-segment elevations, making it a condition that shows more similarities to acute coronary syndrome than viral myocarditis. (4) Conclusions: Myocarditis after streptococcal pharyngitis and/or tonsillitis is a rather infrequently described disease; however, it is necessary to consider this condition when investigating streptococcal sore throat because it can be associated with severe adverse events for the individual patient.

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Section: Resultsmentioning

confidence: 99%

“…Furthermore, ARF generally develops two to four weeks after the initial infection [ 7 ]. In contrast to ARF, nonrheumatic myocarditis following pharyngotonsillitis has a faster onset (usually a few days after streptococcal pharyngitis) and is thought to be caused by streptococcal toxins [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

From Streptococcal Pharyngitis/Tonsillitis to Myocarditis: A Systematic Review

Schmutzler

Mirna

Hoppe

et al. 2022

JCDD

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“…The association of streptococcal infection and cardiac disease is most commonly described with acute rheumatic fever; however, several published case reports describe concomitant streptococcal pharyngitis and myocarditis, termed as acute nonrheumatic streptococcal myocarditis. [1][2][3][4][5][6][7][8] The largest case series described 35 cases of fatal myocarditis associated with nasopharyngeal infections in men aged 20-30 years. 1 Streptococcal pharyngitis and/or streptococcal bacteraemia was demonstrated in 12 of these patients.…”

Section: Discussionmentioning

confidence: 99%

Non-rheumatic streptococcal myocarditis mimicking acute myocardial infarction in an adolescent male

O’Brien

Coulson²,

Sekar³

et al. 2018

Cardiol Young

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An adolescent male with a recent history of streptococcal pharyngitis presented with severe substernal chest pain, troponin leak, and ST-segment elevation, which are suggestive of acute inferolateral myocardial infarction. The coronary angiogram was normal. The patient was subsequently diagnosed with non-rheumatic streptococcal myocarditis. He was treated with amoxicillin and had excellent recovery. Non-rheumatic streptococcal myocarditis is an important mimic of acute myocardial infarction in young adults.

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“…The sudden onset and the rapid recovery following antimicrobial therapy to combat Streptococcus pyogenes , sustains a toxic pathogenesis hypothesis. If ECG disturbances in such situation are accompanied by suggestive symptomatology or increased cardiac enzymes, further investigations as cardiac MRI may be necessary [ 15 ]. Unfortunately, in the absence of symptoms, the TMC of streptococcal infections remain under-recognized and under-reported.…”

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

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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.

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Streptococcal Tonsillitis and Acute Streptococcal Myocarditis: An Unusual Combination Assessed by Cardiac Magnetic Resonance Imaging and Endomyocardial Biopsy

Abstract: Acute streptococcal tonsillitis can be occasionally complicated by myocarditis with either a typical or an atypical presentation. Cardiac MRI can facilitate the diagnosis in both forms and allow a noninvasive follow-up.

Cited by 10 publications

References 13 publications

From Streptococcal Pharyngitis/Tonsillitis to Myocarditis: A Systematic Review

From Streptococcal Pharyngitis/Tonsillitis to Myocarditis: A Systematic Review

Non-rheumatic streptococcal myocarditis mimicking acute myocardial infarction in an adolescent male

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

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