An atypical case of infective endocarditis initially diagnosed as myopericarditis
Background: Acute myopericarditis is inflammation of the pericardium, or the membrane surrounding the heart, and the myocardium, or the muscular myocardial layer of the heart. Infective endocarditis is an infection of the cardiac endothelium. Diagnosis relies on clinical evaluation, blood cultures t...
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Elsevier
2025-03-01
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| author | Negin Ceraolo Rachel Dietz Spencer Prete Erin L Simon |
| author_facet | Negin Ceraolo Rachel Dietz Spencer Prete Erin L Simon |
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| description | Background: Acute myopericarditis is inflammation of the pericardium, or the membrane surrounding the heart, and the myocardium, or the muscular myocardial layer of the heart. Infective endocarditis is an infection of the cardiac endothelium. Diagnosis relies on clinical evaluation, blood cultures to identify the causative organism, and echocardiography to visualize vegetations on heart valves. In the emergency department (ED), distinguishing between myopericarditis and infective endocarditis is crucial to avoid misdiagnosis. Case report: We present the case of a 36-year-old male who was initially hospitalized for myocarditis and discharged on medications with cardiology follow-up planned. Twelve days later, the patient was readmitted with recurring chest pain. A bedside cardiac ultrasound showed mild mitral regurgitation. The patient was found to have bacteremia with Streptococcus anginosus which was concerning for endocarditis. The patient was transferred to a quaternary care hospital, where he underwent successful mitral valve repair. Why should an emergency physician be aware of this?: In the ED setting, it is crucial to broaden differential diagnoses. Myopericarditis can sometimes result from endocarditis, which can present in various ways. Therefore, endocarditis should be ruled out in acute presentations of chest pain. To avoid missing cases of endocarditis, obtaining blood cultures from patients with myopericarditis symptoms is essential. Additionally, expediting a transesophageal echocardiogram (TEE) can lead to a faster and more accurate diagnosis. Promptly conducting these tests can reduce the number of missed endocarditis cases and prevent patients from returning to the emergency department. |
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| spelling | doaj-art-bc89c34ef6544f26ae6a7a4b819ae2412025-02-02T05:29:37ZengElsevierJEM Reports2773-23202025-03-0141100145An atypical case of infective endocarditis initially diagnosed as myopericarditisNegin Ceraolo0Rachel Dietz1Spencer Prete2Erin L Simon3Department of Emergency Medicine, Cleveland Clinic Akron General, 1 Akron General, Akron, OH, 44307, USA; Corresponding author. Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH, 44307, USA.Heritage College of Osteopathic Medicine, 191 W Union St, Athens, OH, 45701, USADepartment of Emergency Medicine, Cleveland Clinic Akron General, 1 Akron General, Akron, OH, 44307, USA; Northeast Ohio Medical University, 4209 OH 44, Rootstown, OH, 44272, USADepartment of Emergency Medicine, Cleveland Clinic Akron General, 1 Akron General, Akron, OH, 44307, USA; Northeast Ohio Medical University, 4209 OH 44, Rootstown, OH, 44272, USABackground: Acute myopericarditis is inflammation of the pericardium, or the membrane surrounding the heart, and the myocardium, or the muscular myocardial layer of the heart. Infective endocarditis is an infection of the cardiac endothelium. Diagnosis relies on clinical evaluation, blood cultures to identify the causative organism, and echocardiography to visualize vegetations on heart valves. In the emergency department (ED), distinguishing between myopericarditis and infective endocarditis is crucial to avoid misdiagnosis. Case report: We present the case of a 36-year-old male who was initially hospitalized for myocarditis and discharged on medications with cardiology follow-up planned. Twelve days later, the patient was readmitted with recurring chest pain. A bedside cardiac ultrasound showed mild mitral regurgitation. The patient was found to have bacteremia with Streptococcus anginosus which was concerning for endocarditis. The patient was transferred to a quaternary care hospital, where he underwent successful mitral valve repair. Why should an emergency physician be aware of this?: In the ED setting, it is crucial to broaden differential diagnoses. Myopericarditis can sometimes result from endocarditis, which can present in various ways. Therefore, endocarditis should be ruled out in acute presentations of chest pain. To avoid missing cases of endocarditis, obtaining blood cultures from patients with myopericarditis symptoms is essential. Additionally, expediting a transesophageal echocardiogram (TEE) can lead to a faster and more accurate diagnosis. Promptly conducting these tests can reduce the number of missed endocarditis cases and prevent patients from returning to the emergency department.http://www.sciencedirect.com/science/article/pii/S2773232025000094Infective endocarditisMyopericarditisChest painMitral valve regurgitationstreptococcus anginosusTransesophageal echocardiogram (TEE) |
| spellingShingle | Negin Ceraolo Rachel Dietz Spencer Prete Erin L Simon An atypical case of infective endocarditis initially diagnosed as myopericarditis JEM Reports Infective endocarditis Myopericarditis Chest pain Mitral valve regurgitation streptococcus anginosus Transesophageal echocardiogram (TEE) |
| title | An atypical case of infective endocarditis initially diagnosed as myopericarditis |
| title_full | An atypical case of infective endocarditis initially diagnosed as myopericarditis |
| title_fullStr | An atypical case of infective endocarditis initially diagnosed as myopericarditis |
| title_full_unstemmed | An atypical case of infective endocarditis initially diagnosed as myopericarditis |
| title_short | An atypical case of infective endocarditis initially diagnosed as myopericarditis |
| title_sort | atypical case of infective endocarditis initially diagnosed as myopericarditis |
| topic | Infective endocarditis Myopericarditis Chest pain Mitral valve regurgitation streptococcus anginosus Transesophageal echocardiogram (TEE) |
| url | http://www.sciencedirect.com/science/article/pii/S2773232025000094 |
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