Streptococcal Tonsillitis and Acute Nonrheumatic Myopericarditis
Today, viruses are usually incriminated in acute myopericarditis in developed countries since diphtheria and rheumatic fever have become rarities. However, streptococcal infections, especially tonsillitis and scarlet fever, may be related to acute nonrheumatic myocarditis during the acute stage of the disease.
A report was made previously of a consecutive series of acute infectious myocarditis patients in Finnish army conscripts during the period from 1977 to 1981. In the series, the most common infectious agents connected with clearcut clinical myopericarditis were vacciniavirus, adenovirus, infectious mononucleosis, Mycoplasma pneumoniae, and Coxsackie B4 virus. Since the completion of the study, two cases have been found of acute myopericarditis mimicking acute myocardial infarction during febrile streptococcal tonsillitis. The present paper reports these two cases. Further, to evaluate the current incidence of myocardial involvement in streptococcal tonsillitis, a prospective screening study was undertaken based on serial electrocardiographic recordings in consecutive patients. Link
A 20-year-old conscript was healthy until he developed a sore throat and fever. Exudative tonsillitis was found on admission. A throat culture yielded group A beta-hemolytic streptococci. Oral penicillin therapy was started on the second day of the symptomatic disease. On the third and fourth days, the patient experienced oppressing nonradiating left-sided chest pain, which was not influenced by respiration. No pericardial rub or gallop sounds were heard. An ECG on the third day showed a ST-segment elevation and peaked T waves in leads 1, 2, aVL, and VM. The voltage on the R wave in lead 1 was reduced, but no Q waves appeared (Fig 1).
Figure 1. Serial ECGs, serum enzyme levels, and echocardiographic findings in case 1 with acute myopericarditis during streptococcal tonsillitis. CK is creatine kinase; LVEDD, left ventricular end diastolic diameter; EF, ejection fraction.