Poveda Velazquez Paula, Khanji Mohammed Y, Laymouna Reem, Pyne Dev, Guttmann Oliver, Sekhri Neha
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Newham University Hospital, Barts Health NHS Trust, London, United Kingdom; William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, London, United Kingdom.
JACC Case Rep. 2025 Sep 3;30(26):104913. doi: 10.1016/j.jaccas.2025.104913.
Myocarditis secondary to Listeria monocytogenes is rare but life-threatening.
A 54-year-old woman with a prior history of systemic lupus erythematous on immunosuppression presented with chest pain and fever. Troponin and C-reactive protein levels were elevated, and an electrocardiogram showed T-wave inversion. Fludeoxyglucose F18 positron emission tomography showed right atrial (RA) uptake. Cardiac magnetic resonance identified RA wall thickening, akinesia, and late gadolinium enhancement, with an associated RA thrombus. Blood cultures were positive for L. monocytogenes. She received antibiotics and anticoagulation. Repeat imaging demonstrated resolution of both RA dysfunction and thrombus resolution.
Myocarditis with atrial involvement is uncommon, often associated with inflammatory or autoimmune conditions. Infectious causes must be excluded before starting immunosuppressive therapy. Cardiac involvement by L. monocytogenes is unusual but may not be infrequent in immunocompromised patients. Early identification and treatment are critical.
TAKE-HOME MESSAGES: Rare causes of myocarditis should always be considered, particularly in immunocompromised patients. Multimodality imaging can help with diagnosis and guide treatment.
由单核细胞增生李斯特菌引起的心肌炎罕见但危及生命。
一名54岁有系统性红斑狼疮病史且正在接受免疫抑制治疗的女性，出现胸痛和发热症状。肌钙蛋白和C反应蛋白水平升高，心电图显示T波倒置。氟脱氧葡萄糖F18正电子发射断层扫描显示右心房摄取。心脏磁共振成像显示右心房壁增厚、运动不能以及钆延迟强化，并伴有右心房血栓形成。血培养单核细胞增生李斯特菌呈阳性。她接受了抗生素治疗和抗凝治疗。重复成像显示右心房功能障碍和血栓均已消退。
累及心房的心肌炎并不常见，常与炎症或自身免疫性疾病相关。在开始免疫抑制治疗前必须排除感染性病因。单核细胞增生李斯特菌累及心脏较为罕见，但在免疫功能低下患者中可能并不少见。早期识别和治疗至关重要。
应始终考虑心肌炎的罕见病因，尤其是在免疫功能低下患者中。多模态成像有助于诊断并指导治疗。
