546 The Diagnosis of Myopericarditis in An Adolescent with Anxiety Disorder Presenting with Chest Pain

Abstract

Background: Chest pain is a common symptom in children and adolescents and has important functional consequences since it may result in restriction of activities, school absenteeism and anxiety in the family. Nevertheless, it's frequently underestimated, especially in adolescence. Case report: A 15-year-old male adolescent, followed as an outpatient by Pedopsychiatry for several years for an anxiety disorder, but otherwise healthy, presented with dull anterior chest pain, more intense in the precordium, which awaked him during the night, subsisting in the morning. The pain had no irradiation and exacerbated with respiratory movements. He complained of dry cough and myalgias since the day before. In the physical examination, was apyretic, hemodynamically stable and a pericardial friction rub was evident in auscultation. Three days ago, he presented a tooth abscess, for which he was taking roxitromicin (600mg/ kg/day). Electrocardiogram showed low voltage in all member derivations, early depolarization and mild ST segment elevation (∽1mm) with upper concavity in all derivations. Two-dimensional echocardiography showed no relevant findings. Blood tests revealed no inflammatory markers rise but considerable troponin I (4.56ng/mL) and CKMB (24.00ng/mL) elevation. Serologies and PCR detection of viral genome were performed. He was treated in ambulatory regimen with acetylsalicylic acid (100mg/kg/day). Comments: In this case, a thorough history and physical examination, along with electrocardiogram and laboratory testing, revealed an organic cause for chest pain that could otherwise have been undiagnosed or attributed to a psychogenic cause. Despite the benign course of this case of myopericarditis, without adequate treatment it could have gone differently.