Surprising diagnosis in a patient with acute coronary syndrome: A case report of acute streptococcal pharyngitis-associated perimyocarditis

Abstract

Background Streptococcal pharyngitis is a common infection, with both suppurative and non-suppurative complications. Most importantly, a streptococcal infection can cause heart disease in different pathophysiological pathways. Acute nonrheumatic perimyocarditis appears to be a more frequent pathological entity associated with streptococcal pharyngitis as once thought, which is poorly understood and explored.Case summary We present the case of a middle-aged man with acute chest pain, electrocardiogram (ECG) abnormalities, and elevated cardiac enzymes following a recent episode of pharyngitis in which streptococcal-associated perimyocarditis was diagnosed. Cardiovascular magnetic resonance (CMR) imaging established the diagnosis and allowed cardiac disease monitoring after successful antibiotic therapy resulting in complete clinical recovery. Discussion Patients presenting with acute chest pain, ECG abnormalities, and cardiac enzyme elevations do not always suffer from an ischaemic heart attack. A thorough investigation comprising a detailed past medical history and noninvasive imaging such as CMR are the cornerstones for unravelling a correct diagnosis and implementing a proper treatment-as was shown in the present clinical case.