Abstract
Introduction: The most common cause of acute myocarditis in developed countries is viruses. Bacterial myocarditis is very rare and caused by various bacteria, but only three cases have been reported in the past where Shigella sonnei was the aetiology. Two out of the three cases reported were in a paediatric population. Case Presentation: A 38-year-old female was presenting with chest pain and an increased level of troponins with the EKG (electrocardiogram) showing non-specific T-wave changes. Preceding the chest pain, the patient had Shigella sonnei gastroenteritis confirmed by stool culture. The patient's cardiac catheterization showed normal findings. Thus a diagnosis of bacterial myocarditis was made. The event resolved after successful treatment of the gastroenteritis with ciprofloxacin. Conclusion: We are reporting a very rare case of Shigella sonnei gastroenteritis that resulted in the development of acute myocarditis and was successfully treated with antibiotics.
Highlights
The most common cause of acute myocarditis in developed countries is viruses
Shigella sonnei has rarely been cited as one of the causes of bacterial myocarditis with only a handful of patients reported in the literature (Caraco et al, 1987; Rubenstein et al, 1993)
A case was reported in 1987 for a 19-year-old young adult who had myocarditis secondary to shigellosis in the form of acute EKG changes and a murmur that resolved in 5 days (Caraco et al, 1987)
Summary
The most common cause of acute myocarditis in developed countries is viruses. Bacterial myocarditis is very rare and can be caused by multiple bacteria. Four days after the diarrhoea onset and 3 days before admission, she started experiencing intermittent pressure like chest pain, which was mid-sternal and associated with diaphoresis and nausea. She tried over-thecounter famotidine (Pepcid) with no relief. Oral 500 mg ciprofloxacin tablet was started twice daily on the same day of admission to the hospital, at the same time the stool samples were sent to the lab. Anti-nuclear antibody was weakly positive speckled (1 : 80, normal1 : 40) At this point, due to absence of coronary artery disease a diagnosis of myocarditis secondary to a food-borne pathogen was made. Follow-up was obtained in 3 weeks and the patient had no complaints, with a normal clinical exam and EKG showing sinus bradycardia without any ST-T-wave changes (Fig. 2)
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