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Acute myocarditis complicated with permanent complete atrioventricular block caused by Escherichia coli bacteremia: A rare case report.
Medicine (Baltimore). 2019 Nov; 98(44):e17833.M

Abstract

RATIONALE

Acute myocarditis complicated with complete atrioventricular block (CAVB) is rare in clinical scenario. We report an uncommon case of myocarditis complicated with permanent CAVB caused by Escherichia coli (E coli) bacteremia.

PATIENT CONCERNS

A 77-year-old woman presented at the emergency department with chest pain, dizziness, nausea, and cold sweats of 1-day duration. She had histories of type 2 diabetes mellitus, hyperlipidemia, and chronic kidney disease with regular medical therapy.

DIAGNOSIS

Both blood and urine cultures were positive for E coli. Regional inferior wall motion abnormalities on echocardiography, unexplained life-threatening arrhythmias, newly abnormal electrocardiogram, elevated cardiac troponins, and healthy coronary arteries on angiography were consistent with E coli-induced myocarditis.

INTERVENTIONS

The patient received implantation of a dual-chamber pacemaker because of irreversible CAVB.

OUTCOMES

The patient was discharged on day 8 and remained asymptomatic at 15 months of follow-up, with ST-segment normalization and normal left ventricular function.

LESSONS

This extremely rare case of E coli-induced myocarditis masquerading as acute STEMI and with permanent CAVB sequelae, highlights the importance of sensitivity to non-ischemia etiologies of ST-segment elevation and the potential impact of E coli sepsis on the cardiac conduction system.

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Authors+Show Affiliations

Hsu CT
Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei. Division of Cardiology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan.
Hsiao PJ
Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan. Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei. Department of Life Sciences, National Central University, Taoyuan City. Division of Nephrology, Department of Medicine, Fu Jen Catholic University Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City.
Liu CH
Division of Cardiology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung.
Chou YL
Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei.
Chen BH
Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.
Liou JT
Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei.

MeSH

Acute DiseaseAgedAtrioventricular BlockBacteremiaCardiac Pacing, ArtificialEscherichia coli InfectionsFemaleHumansMyocarditis

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

31689871

Citation

Hsu, Ching-Tsai, et al. "Acute Myocarditis Complicated With Permanent Complete Atrioventricular Block Caused By Escherichia Coli Bacteremia: a Rare Case Report." Medicine, vol. 98, no. 44, 2019, pp. e17833.
Hsu CT, Hsiao PJ, Liu CH, et al. Acute myocarditis complicated with permanent complete atrioventricular block caused by Escherichia coli bacteremia: A rare case report. Medicine (Baltimore). 2019;98(44):e17833.
Hsu, C. T., Hsiao, P. J., Liu, C. H., Chou, Y. L., Chen, B. H., & Liou, J. T. (2019). Acute myocarditis complicated with permanent complete atrioventricular block caused by Escherichia coli bacteremia: A rare case report. Medicine, 98(44), e17833. https://doi.org/10.1097/MD.0000000000017833
Hsu CT, et al. Acute Myocarditis Complicated With Permanent Complete Atrioventricular Block Caused By Escherichia Coli Bacteremia: a Rare Case Report. Medicine (Baltimore). 2019;98(44):e17833. PubMed PMID: 31689871.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute myocarditis complicated with permanent complete atrioventricular block caused by Escherichia coli bacteremia: A rare case report. AU - Hsu,Ching-Tsai, AU - Hsiao,Po-Jen, AU - Liu,Ching-Han, AU - Chou,Yen-Lien, AU - Chen,Bo-Hau, AU - Liou,Jun-Ting, PY - 2019/11/7/entrez PY - 2019/11/7/pubmed PY - 2019/11/14/medline SP - e17833 EP - e17833 JF - Medicine JO - Medicine (Baltimore) VL - 98 IS - 44 N2 - RATIONALE: Acute myocarditis complicated with complete atrioventricular block (CAVB) is rare in clinical scenario. We report an uncommon case of myocarditis complicated with permanent CAVB caused by Escherichia coli (E coli) bacteremia. PATIENT CONCERNS: A 77-year-old woman presented at the emergency department with chest pain, dizziness, nausea, and cold sweats of 1-day duration. She had histories of type 2 diabetes mellitus, hyperlipidemia, and chronic kidney disease with regular medical therapy. DIAGNOSIS: Both blood and urine cultures were positive for E coli. Regional inferior wall motion abnormalities on echocardiography, unexplained life-threatening arrhythmias, newly abnormal electrocardiogram, elevated cardiac troponins, and healthy coronary arteries on angiography were consistent with E coli-induced myocarditis. INTERVENTIONS: The patient received implantation of a dual-chamber pacemaker because of irreversible CAVB. OUTCOMES: The patient was discharged on day 8 and remained asymptomatic at 15 months of follow-up, with ST-segment normalization and normal left ventricular function. LESSONS: This extremely rare case of E coli-induced myocarditis masquerading as acute STEMI and with permanent CAVB sequelae, highlights the importance of sensitivity to non-ischemia etiologies of ST-segment elevation and the potential impact of E coli sepsis on the cardiac conduction system. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/31689871/Acute_myocarditis_complicated_with_permanent_complete_atrioventricular_block_caused_by_Escherichia_coli_bacteremia:_A_rare_case_report_ DB - PRIME DP - Unbound Medicine ER -