Hiraiwa Hiroaki, Morimoto Ryota, Ando Ryota, Ito Ryota, Araki Takashi, Mizutani Takashi, Kazama Shingo, Kimura Yuki, Oishi Hideo, Kuwayama Tasuku, Yamaguchi Shogo, Kondo Toru, Okumura Takahiro, Enomoto Atsushi, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Pathology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Cardiol Cases. 2022 Mar 23;26(1):62-65. doi: 10.1016/j.jccase.2022.02.004. eCollection 2022 Jul.
A 42-year-old man with a history of acute myocarditis after streptococcal pharyngitis developed recurrent fulminant myocarditis. Endomyocardial biopsy revealed myocyte degeneration, interstitial edema, and neutrophil infiltration. The patient's cardiac function deteriorated rapidly, and he died despite mechanical circulatory support. Autopsy revealed neutrophil infiltration, interstitial edema, and micro-abscesses containing masses of streptococci and neutrophilic phagocytosis within the myocardium. The patient did not meet the diagnostic criteria for acute rheumatic fever; thus, he was diagnosed with non-rheumatic streptococcal myocarditis. Non-rheumatic streptococcal myocarditis rarely recurs, but it can be fulminant upon recurrence.
We report a rare case of recurrent fulminant non-rheumatic streptococcal myocarditis. Endomyocardial biopsy and autopsy revealed neutrophil infiltration and micro-abscesses containing bacterial masses of streptococci and neutrophilic phagocytosis in the myocardium. The patient did not meet the diagnostic criteria for acute rheumatic fever; thus, he was diagnosed with non-rheumatic streptococcal myocarditis. Non-rheumatic streptococcal myocarditis rarely recurs, but it can be fulminant upon recurrence.
一名42岁男性，有链球菌性咽炎后急性心肌炎病史，发生了复发性暴发性心肌炎。心内膜心肌活检显示心肌细胞变性、间质水肿和中性粒细胞浸润。患者的心功能迅速恶化，尽管接受了机械循环支持仍死亡。尸检显示心肌内有中性粒细胞浸润、间质水肿以及含有大量链球菌的微脓肿和嗜中性吞噬现象。该患者不符合急性风湿热的诊断标准；因此，他被诊断为非风湿性链球菌性心肌炎。非风湿性链球菌性心肌炎很少复发，但复发时可能呈暴发性。
我们报告一例罕见的复发性暴发性非风湿性链球菌性心肌炎病例。心内膜心肌活检和尸检显示心肌中有中性粒细胞浸润以及含有链球菌菌团和嗜中性吞噬现象的微脓肿。该患者不符合急性风湿热的诊断标准；因此，他被诊断为非风湿性链球菌性心肌炎。非风湿性链球菌性心肌炎很少复发，但复发时可能呈暴发性。
