Challenging differential diagnosis, Unusual setting of medical care, Rare disease
Haider Alkhateeb, Sarmad Said, Chad J. Cooper, Sherif Elhanafi, Mohamed Teleb, Fatima Saifuddin, Debabrata Mukherjee, Aamer Abbas, Harry E. Davis II
Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, USA
Am J Case Rep 2014; 15:82-84
Background: Myopericarditis is a condition involving inflammation of the pericardium and myocardium. It has been reported in conjunction with inflammatory bowel disease as well as infectious colitis caused by a cardiotropic organism. The etiology of myopericarditis includes a long list of infectious causes (especially viral), toxic causes, autoimmune disorders, and vasculitides.
Case Report: A 31-year-old previously healthy Hispanic man complained of sudden onset of watery, non-bloody diarrhea associated with mucus and crampy abdominal pain. ECG showed ST-segment elevation in the infero-lateral leads, with elevated troponin I level. Urgent cardiac catheterization revealed normal coronary arteries and the patient was diagnosed with myopericarditis. The echocardiogram results were within normal limits, with 65% ejection fraction and no evidence of wall motion abnormalities. Colonoscopy showed macroscopically congested mucosa in the descending colon, sigmoid colon, and rectum, with scattered petechiae indicative of nonspecific colitis. Microscopic examination of obtained biopsies revealed evidence of acute mucosal inflammation without ulceration, granulomas or ischemia. The patient was started on Naproxen 250 mg twice daily and chest pain started to improve gradually. The patient was discharged on Naproxen and was followed up in clinic 2 weeks after discharge, where he was found to be completely asymptomatic, with troponin level <0.015 ng/ml.
Conclusions: Myopericarditis is a challenging diagnosis that has been reported in association with colitis, either as an extraintestinal manifestation of IBD or due to infectious colitis with a cardiotropic organism.
Keywords: myopericarditis, Colitis, Pericarditis, Chest Pain