Myocarditis as a Complication of Campylobacter jejuni-Associated Enterocolitis: A Report of Two Cases

Abstract

Myocarditis refers to inflammation of the heart muscle and may occur individually or together with pericarditis, which refers to inflammation of the saclike tissue layer that surrounds the heart. They may have infectious or non-infectious etiologies. Campylobacter jejuni, a major cause of gastroenteritis worldwide, may also cause myocarditis in rare situations. We present two cases highlighting this rare complication of diarrheal disease caused by Campylobacter jejuni infection and subsequent development of myocarditis. Both patients presented with chest pain and multiple episodes of watery diarrhea, with initial EKGs showing ST segment changes, as well as elevated inflammatory markers and elevated troponins. GI panels for both patients were positive for Campylobacter jejuni. Based on their presentations and investigative findings, they were diagnosed with myocarditis secondary to Campylobacter infection, and their symptoms subsided with appropriate management. It is unclear if the myocardial damage, in this case, is a direct effect of the toxin on cardiac myocytes or secondary to an immunologic phenomenon. Regardless, Campylobacter jejuni-associated myocarditis remains a rare phenomenon and needs to be considered in the differential of patients presenting with concurrent chest pain and diarrheal symptoms.

Keywords: adult cardiology; campylobacter enteritis; campylobacter enteritis myocarditis; campylobacter extraintestinal manifestations; enterocolitis.

Figure 1. EKG findings of nonspecific ST elevation in leads V2-V5

EKG: Electrocardiogram

Figure 2. EKG finding of ST segment elevation in leads II, III, and aVF with reciprocal ST depressions noted in lead I and aVL

EKG: Electrocardiogram