P90 CAMPYLOBACTER JEJUNI–ASSOCIATED MYOCARDITIS: A RARE BACTERIAL TRIGGER OF ACUTE MYOCARDITIS

Abstract

Abstract Introduction Acute myocarditis is an important cause of chest pain in the young, with potential acute arrhythmic and hemodynamic complications and possible evolution into chronic inflammatory cardiomyopathy. Even though multiple triggers can be recognized, bacterial infections are rarely associated with myocarditis in immunocompetent patients. Case report A 22–year–old Caucasian woman presented to the Emergency Department with stabbing chest pain exacerbated by breathing, for several hours, without fever. She experienced diarrhea and gastroenteric symptoms for 4 days. One year prior she experienced identical pain during an acute myocarditis episode, with no clear trigger. The patient’s father too suffered from myocarditis a few months earlier. She underwent routine blood tests with evidence of elevated troponin HS (peak 8000 ng/L) and PCR (82mg/L). ECG showed sinus rhythm and anterolateral concave ST elevation of a maximum of 2 mm. Echocardiography showed normal bi–ventricular dimensions, thickness, regional motion, and absence of pericardial effusion. MRI exhibited inferolateral subepicardial edema and late gadolinium enhancement (LGE). The previous MRI performed 6 months after the resolution of the previous myocarditis did not show any LGE or edema. We began empirical anti–inflammatory therapy with swift benefit. Due to the persistence of gastroenteric symptoms, fecal film array and coproculture were performed and resulted positive for Campylobacter Jejuni, treated with Azithromycin 500 mg/day for 3 days. Finally, considering the recurrent event and the family history of myocarditis in the father, a genetic test was planned to exclude a “hot phase” in the context of arrhythmogenic cardiomyopathy. Discussion Up to 80% of acute myocarditis has an infectious trigger. The recent 2020 consensus advises against routine serology unless specific pathogens are suspected. In the literature, Campylobacter Jejuni is reported as a trigger of various inflammatory diseases, including acute myocarditis. We suggest investigating the presence of this bacterium in stool in case of active gastroenteric symptoms and adding targeted antibiotic therapy in case of active bacterial infection. Previous case reports excluded viral in myocarditis patients positive for Campylobacter. This may support C. Jejuni’s causal role and not as an innocent bystander.