Abstract 13689: A Case of Myopericarditis Caused by Salmonella

Abstract

Introduction: Salmonella is a gram-negative bacteria that usually causes self-limiting diarrhea. It is a rare infectious etiology of myopericarditis. Here we present a case of a young healthy male with Salmonella diarrhea who developed myopericarditis. Case: 26 year-old male with no medical history presented with chest pain for several hours, improved by sitting upright. He also endorsed fevers, watery diarrhea, nausea, and body aches for the past 5 days. Vital signs and physical exam were within normal limits. Complete blood count and comprehensive metabolic panel were unremarkable but high sensitivity troponin T was 125 and peaked at 434. ESR and CRP were elevated. EKG showed minimal up-sloping ST-elevations diffusely with PR-elevation in lead aVR. Chest X-ray was clear. Patient was started on aspirin, clopidogrel, heparin drip, and low dose beta-blocker for empiric treatment of acute coronary syndrome as well colchicine for pericarditis. Transthoracic echocardiogram showed normal ventricular functions and no pericardial effusion. Cardiac MRI showed myocardial late gadolinium enhancement involving the outer wall of the lateral, inferolateral, and inferior walls of the basal left ventricle corresponding to myocarditis. At this point heparin was stopped and patient was transitioned to high dose aspirin with resolution of chest pain. He was continued on the beta-blocker for arrhythmia prevention in the setting of myocarditis. All infectious work up including respiratory viral panel, COVID PCR and antibodies, and blood cultures were unremarkable except stool PCR that was positive for Salmonella species. Infectious disease was consulted and he was given one dose of ceftriaxone and 7 days of azithromycin. Patient was discharged with close follow-up. Conclusions: Salmonella myopericarditis is rare and more often described in immunocompromised patients. Our case highlights this condition in an immunocompetent male. Cardiac treatment is supportive with volume optimization and arrhythmia prevention. Early liaison with infectious specialists in treatment of the infection is important given various region-dependent antibiotic susceptibilities.