Tags

Type your tag names separated by a space and hit enter

Trichinella spiralis-associated myocarditis mimicking acute myocardial infarction.
Acta Clin Belg. 2020 Jul 04 [Online ahead of print]AC

Abstract

Background Trichinellosis is a parasitic infection caused by nematodes of the genus Trichinella, and its principal mode of transmission is the consumption of raw or undercooked contaminated meat. Cardiac involvement in trichinellosis is unusual, yet it represents the most frequent cause of death. Here, we report a case in which Trichinella spiralis-associated myocarditis simulated a myocardial infarction. Case presentation A 35-year-old African man with no previous medical history was admitted to the emergency department for acute substernal discomfort at rest described as a pressure with no radiation. The electrocardiogram performed upon admission showed non-specific alterations of repolarization. Blood biology revealed high levels of troponin T and predominant eosinophilic leukocytosis. A transthoracic echocardiography was carried out and found a significant left ventricular concentric hypertrophy with a preserved ejection fraction. The septal and inferior walls, as well as the endocardium were hyperechogenic. The patient was hospitalized for eosinophilic myocarditis. The cause of hypereosinophilia was investigated, and a Trichinella spiralis serology came back strongly positive. A diagnosis of Trichinella spiralis associated-myocarditis was made. The patient was treated with albendazole-prednisolone dual therapy with favorable clinical and biological outcomes. Conclusion The clinical suspicion of trichinellosis is based on suggestive epidemiology associated with the typical clinical presentation and the presence of eosinophilia. Eosinophilic myocarditis is a severe complication of trichinellosis which can result in death due to rhythm disorders. Chest pain, increase in troponins, and electrocardiographic abnormalities are all elements that can mimic a myocardial infarction and mislead clinicians. Abbreviations ANCA: Anti-Neutrophil Cytoplasmic Antibodies; ANA: Anti-Nuclear Antibodies; ECDC: European Centre for Disease Prevention and Control; ECG: Electrocardiogram; ELISA: Enzyme-Linked ImmunoSorbent Assay; EMF: Endomyocardial Fibrosis; ES: Excretory-Secretory; ICT: International Commission on Trichinellosis; MRI: Magnetic Resonance Imaging.

Authors+Show Affiliations

Internal Medicine Department, Brugmann University Hospital , Brussels, Belgium.Department of Infectious Diseases, Brugmann University Hospital , Brussels, Belgium.Laboratory of Parasitology, Université Libre De Bruxelles , Brussels, Belgium.Department of Cardiology, Brugmann University Hospital , Brussels, Belgium.Department of Cardiology, Brugmann University Hospital , Brussels, Belgium.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32627690

Citation

Mohib, Othmane, et al. "Trichinella Spiralis-associated Myocarditis Mimicking Acute Myocardial Infarction." Acta Clinica Belgica, 2020, pp. 1-6.
Mohib O, Clevenbergh P, Truyens C, et al. Trichinella spiralis-associated myocarditis mimicking acute myocardial infarction. Acta Clin Belg. 2020.
Mohib, O., Clevenbergh, P., Truyens, C., Morissens, M., & Castro Rodriguez, J. (2020). Trichinella spiralis-associated myocarditis mimicking acute myocardial infarction. Acta Clinica Belgica, 1-6. https://doi.org/10.1080/17843286.2020.1790867
Mohib O, et al. Trichinella Spiralis-associated Myocarditis Mimicking Acute Myocardial Infarction. Acta Clin Belg. 2020 Jul 4;1-6. PubMed PMID: 32627690.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trichinella spiralis-associated myocarditis mimicking acute myocardial infarction. AU - Mohib,Othmane, AU - Clevenbergh,Philippe, AU - Truyens,Carine, AU - Morissens,Marielle, AU - Castro Rodriguez,José, Y1 - 2020/07/04/ PY - 2020/7/7/entrez KW - Trichinellosis KW - eosinophilia KW - myocarditis KW - parasitosis KW - trichinosis SP - 1 EP - 6 JF - Acta clinica Belgica JO - Acta Clin Belg N2 - Background Trichinellosis is a parasitic infection caused by nematodes of the genus Trichinella, and its principal mode of transmission is the consumption of raw or undercooked contaminated meat. Cardiac involvement in trichinellosis is unusual, yet it represents the most frequent cause of death. Here, we report a case in which Trichinella spiralis-associated myocarditis simulated a myocardial infarction. Case presentation A 35-year-old African man with no previous medical history was admitted to the emergency department for acute substernal discomfort at rest described as a pressure with no radiation. The electrocardiogram performed upon admission showed non-specific alterations of repolarization. Blood biology revealed high levels of troponin T and predominant eosinophilic leukocytosis. A transthoracic echocardiography was carried out and found a significant left ventricular concentric hypertrophy with a preserved ejection fraction. The septal and inferior walls, as well as the endocardium were hyperechogenic. The patient was hospitalized for eosinophilic myocarditis. The cause of hypereosinophilia was investigated, and a Trichinella spiralis serology came back strongly positive. A diagnosis of Trichinella spiralis associated-myocarditis was made. The patient was treated with albendazole-prednisolone dual therapy with favorable clinical and biological outcomes. Conclusion The clinical suspicion of trichinellosis is based on suggestive epidemiology associated with the typical clinical presentation and the presence of eosinophilia. Eosinophilic myocarditis is a severe complication of trichinellosis which can result in death due to rhythm disorders. Chest pain, increase in troponins, and electrocardiographic abnormalities are all elements that can mimic a myocardial infarction and mislead clinicians. Abbreviations ANCA: Anti-Neutrophil Cytoplasmic Antibodies; ANA: Anti-Nuclear Antibodies; ECDC: European Centre for Disease Prevention and Control; ECG: Electrocardiogram; ELISA: Enzyme-Linked ImmunoSorbent Assay; EMF: Endomyocardial Fibrosis; ES: Excretory-Secretory; ICT: International Commission on Trichinellosis; MRI: Magnetic Resonance Imaging. SN - 2295-3337 UR - https://www.unboundmedicine.com/medline/citation/32627690/Trichinella_spiralis-associated_myocarditis_mimicking_acute_myocardial_infarction L2 - http://www.tandfonline.com/doi/full/10.1080/17843286.2020.1790867 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.