Myocarditis Associated with Campylobacter jejuni Infection

Abstract

An increasing number of reported cases suggest that Campylobacter jejuni (C. jejuni) has a wide pathogenic spectrum of extra-intestinal complications: Guillan Barré Syndrome, reactive arthritis and uveitis. We would like to present a case of myocarditis associated with C. jejuni enterocolitis. Case report: A previously healthy 21 year old Caucasian male presented two weeks after a trip to Corsica with fever and profuse diarrhea, with intermittent blood. Two days later, patient developed shortness of breath and chest pain. Patient had no prior surgeries. The physical exam was unremarkable, with the exception of tachycardia. Chest X-ray revealed an enlarged heart, and ECG demonstrated non-specific T-wave abnormalities. Echocardiogram demonstrated normal wall motion. WBC, ESR and Urine Toxicology were normal. Creatinine kinase and troponin were significantly elevated. The initial stool, blood and urine bacterial cultures as well as stool ova and parasites and viral cultures did not reveal any pathogens. Viral serologies were also negative. Patient was given a diagnosis of myocarditis and was treated supportively. Due to the unresolving diarrhea, colonoscopy was performed. The colonoscopy revealed erythematous, friable mucosa with multiple deep ulcers in the sigmoid colon (Figure 1). The pathology specimen revealed acute colitis with cryptitis and crypt abcesses. Stool culture of an aspirate obtained during colonoscopy revealed C.jeuni. Within one week of hospitalization patient improved. At 30 days follow up, the patient was symptom free, without further diarrhea or chest pain. Review of the literature reveals 14 case reports worldwide of myocarditis associated with C jejuni infection. The pathogenesis is unknown; however, it has been suggested that myocarditis develops either as a result of bacteremia or as a result of a secondary immune reaction. Myocarditis can present as sequelae of C jejuni infection. C jejuni should be considered as a culprit whenever there is a presentation of diarrhea in conjunction with myocarditis-like symptoms. [figure1]Figure