Clinical Characteristics and Outcomes of Patients with Nonrheumatic Streptococcal Pharyngitis-Associated Myocarditis - 13/02/25

Doi : 10.1016/j.amjmed.2025.01.003

Wesam Mulla, MD PhD ^a,^b,^{^{†
Both authors contributed equally to the manuscript.},}^⁎ , Anan Younis, MD ^a,^d,^{^{†
Both authors contributed equally to the manuscript.}}, Sana Zahalka, BSc ^b, Anat Wieder, MD ^c,^d, Dafna Yahav, MD ^c,^d, Amitai Segev, MD ^a,^d, Israel Mazin, MD ^a,^d, Raphael Kuperstein, MD ^a,^d, Michael Arad, MD ^a,^d, Shlomi Matetzky, MD ^a,^d, Roy Beigel, MD ^a,^d
^a Division of Cardiology, Sheba Medical Center, Ramat Gan, Israel
^b Division of Internal Medicine, Sheba Medical Center, Ramat Gan, Israel
^c Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel
^d The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

^⁎Requests for reprints should be addressed to Wesam Mulla, MD, PhD, Sheba Medical Center, Tel Hashomer, Sheba Road 2, Ramat Gan, 52620 IsraelSheba Medical CenterTel HashomerSheba Road 2Ramat Gan52620Israel

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 13 February 2025

Abstract

Background

Reports of nonrheumatic streptococcal pharyngitis-associated myocarditis (SPAM) are rare, and its incidence, pathophysiology, and clinical features remain unclear. We evaluated the clinical course and outcome of patients diagnosed with nonrheumatic SPAM, with a particular focus on differentiating it from other etiologies of myocarditis.

Methods

Seventy-nine consecutive individuals (age 32 ± 9 years, 71 men) with clinically diagnosed SPAM were evaluated. None satisfied the revised Jones criteria for diagnosis of acute rheumatic fever.

Results

Average onset of symptoms prior to hospitalization was 5.44 ± 5.16 days, all had sore throat and were treated with antibiotics for 10 days; Clinical presentation was characterized by chest pain (91%), fever (90%), electrocardiographic ST-segment elevation (80%), and biochemical evidence of myocyte necrosis (100%). In 27 cases, coronary angiography was performed and in all either normal or nonsignificant coronary artery disease was found. Cardiac magnetic resonance imaging was done in 61 cases and demonstrated subepicardial late gadolinium enhancement (90%) predominantly in the lateral (85%) and inferior (75%) sides.

Conclusions

Nonrheumatic SPAM may not be as infrequent as thought and should be considered in the differential diagnosis of acute ST-segment elevation myocardial infarction, especially in young male patients with sore throat and fever.

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Keywords : Myocarditis, Sore throat, Streptococcal pharyngitis, ST-segment elevation myocardial infarction

Plan

	Funding: None.
	Conflicts of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
	Authorship: The authors take full responsibility for the content of the article. All authors had access to the data and a role in writing this manuscript. WM: Writing – original draft, Visualization, Methodology, Investigation, Formal analysis, Conceptualization; AY: Writing – review & editing, Visualization, Validation, Methodology, Investigation, Formal analysis, Data curation, Conceptualization; SZ: Writing – review & editing, Visualization; AW: Writing – review & editing; DY: Writing – review & editing; AS: Writing – review & editing, Data curation; IM: Writing – review & editing, Data curation; RK: Writing – review & editing; MA: Writing – review & editing; SM: Writing – review & editing; RB: Writing – review & editing, Visualization, Validation, Supervision, Project administration, Methodology, Investigation, Conceptualization.