Myocarditis in a patient with Campylobacter enteritis

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Melina Manning
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1 Myocarditis in a patient with Campylobacter enteritis Dries De Cock, M.D. University Hospitals Leuven Department of Cardiology Herestraat Leuven - Belgium

2 DECLARATION OF CONFLICT OF INTEREST No disclosures

RR tenderness over the left hemiabdomen and hyperperistalsis normal cardiac and pulmonary auscultation

3 42-year-old patient History: abnormal tiredness and dyspnea extensive watery diarrhea since 6 days treament with ofloxacine was unsuccesfull Physical examination: dehydrated man 100/69 mmhg - 82/min, RR tenderness over the left hemiabdomen and hyperperistalsis normal cardiac and pulmonary auscultation Lab analysis: C-reactive protein 112 mg/l (< 5.0) Troponin I 3.67 µg/l (< 0.13) NT-proBNP 1722 ng/l (< 115)

4 T2- weighted Positive stool culture for Campylobacter jejuni, resistant to quinolones Hemocultures were sterile Serological testing for Coxsackie viruses and Salmonella remained negative R/ azithromycine for 3 days and ACEinhibitors were started T1- late enhancement

6 34-year-old 21-year-old

Cardiac-related symptoms Campylobacterspecific results (2) 1984 3 days Chest pain Positive stool culture, serological antibody test (3) 2001 2 weeks Breathlessness, chest pain Positive stool culture,

7 Table - Diagnostic procedures and antibiotic treatment in patients with Campylobacter-associated myocarditis Case patient Ref. Year Time between onset of enteritis and cardiacrelated symptoms 23-year-old 32-year-old 30-year-old 43-year-old 30-year-old 47-year-old 16-year-old 24-year-old 19-year-old 16-year-old 17-year-old Cardiac-related symptoms Campylobacterspecific results (2) days Chest pain Positive stool culture, serological antibody test (3) weeks Breathlessness, chest pain Positive stool culture, serological antibody tests Cardiac markers ECG-changes Echocardiography Cardiac MRI Biopsy Antibiotic treatment CK* 1165 U/L CK 399 U/L (4) days Breathlessness, chest pain Positive stool culture CK 289 U/L Trop I # 30.2 µg/l T-wave inversion (5) days Chest pain Positive stool culture CK 405 U/L ST-segment depression (5) days Chest pain Positive stool culture CK 535 U/L ST-segment elevation (6) days Chest pain Positieve stool culture, CK-MB 17.9 µg/l T-wave serological antibody abnormality test (7) days Chest pain, shock Outcome No abnormality Not performed Not performed No treatment Benign course Beningn course No abnormality Not performed Not performed Ciprofloxacin Benign course No abnormality Not performed Not performed Erythromycin Benign course No abnormality Not performed Not performed Erythromycin Bening course Pericardial effusion, septal hypokinesia Not performed Not performed Roxithromycin Benign course Positive stool culture CK > U/L Not performed Not performed Not performed Infiltration with polymorphonuclear No treatment Death (8) days Chest pain Positive stool culture leukocytes Trop T 1.4 ng/ml ST-segment Akinetic apical Patchy delayed Not performed presenting elevation symptom segments, Erythromycin Benign course pericardial following (9) days effusion gadolinium Palpitations, Positive stool culture CK 345 U/L ST-segment Not performed Spotted delayed Not performed Ciprofloxacin chest pain Trop T 0.52 ng/ml IV. Generally benign course elevation Benign course following (10) days gadolinium Chest pain, Positive stool culture, CK 1432 U/L ST-segment Globally reduced Not performed Not performed Clarithomycin 1 report of fatal myocarditis breathlessness serological antibody Trop T 1.7 ng/ml elevation systolic left Benign course test ventricular (10) days Chest pain Positive stool culture CK 594 U/L Trop T 0.79 ng/ml 21-year-old (11) 2010 some days Chest pain Positive stool cultures CK 2416 U/L Trop I 2.5 µg/l * CK: elevation of serum creatine kinase # Trop I: elevation of serum tropnin I I. Young (white) patients years old T-wave inversion II. Time delay between onset T-wave Dilated left Diffuse delayed Not performed Intravenous inversion ventricle with enhancement gentamycin globally impaired following of GI symptoms systolic function gadolinium and cardiacrelated symptoms short between 2 days and 2 weeks III. Chest pain mainly the ST-segment elevation ST-segment elvation function No abnormality Patchy delayed enhancement following gadolinium Not performed Clarithromycin Benign course No abnormality Not performed Not performed Not specified Benign course

Following viral myocarditis, which athlete can re-enter his active sports career?

Following viral myocarditis, which athlete can re-enter his active sports career? ESC Congress 2011 Paris F. Carré University Rennes 1-Pontchaillou Hospital Inserm U642, Rennes - F-35000 The author declares