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Salmonella enteritidis Infection Complicated by Acute Myocarditis: A Case Report and Review of the Literature

DOI: 10.4061/2011/574230

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Abstract:

Salmonella spp. is the cause of commonly encountered infections, with seasonal pattern of occurrence and worldwide distribution. Some of the clinical manifestations such as gastroenteritis and bacteremia are common, whereas others like mycotic aneurysms and osteomyelitis are infrequent especially in immunocompetent patients. Salmonella has been rarely described as a cause of myocarditis in the literature. We describe a case of an 18-year-old previously healthy male patient with myocarditis after Salmonella enteritidis infection. Clinical manifestations and diagnostic approach of this severe complication are discussed with a review of the literature. 1. Introduction Myocarditis, clinically defined as inflammation of the myocardium, has a broad spectrum of causes including infectious, immune-mediated, and toxic [1]. The role of viruses as etiological factors, especially coxsackievirus and adenovirus, has been thoroughly investigated over the years [1]. The role of bacterial infections is obscure, as these infections are thought to be less commonly associated with myocarditis [1]. Nontyphoidal Salmonella gastroenteritis is a food-borne infection, which is usually self-limited. Bacteremia or other invasive complications are rare in immunocompetent persons. We present a previously healthy male patient with acute myocarditis following Salmonella enteritidis infection. We also discuss the role of biomarkers of cardiac injury, ECG, echocardiogram, and endomyocardial biopsy in the diagnosis of myocarditis, in cases that follow infection with Salmonella spp. 2. Case Report A 18-year-old previously healthy male presented to the emergency department (ED) of our hospital, with a 48-hour history of >20/day profuse, watery, nonbloody diarrheas, 5 times of vomiting, generalized abdominal, pain and fever up to 40°C. His previous medical record was clear from coronary artery risk factors or any other pathology. On the same day and before attending our ED, he had visited another hospital. No laboratory studies were performed there, and after administration of i.v. liquid and electrolyte replacement, he was discharged with the diagnosis of gastroenteritis. Of relevance, 2 days before the onset of symptoms, the patient had eaten fried rice with egg and chicken in a Chinese restaurant. Physical examination on admission to the hospital revealed temperature 40.1°C, blood pressure 110/80?mmHg, heart rate 100 per minute, and respiratory rate 25 per minute. Cardiac examination was normal. Abdominal examination demonstrated generalized tenderness. Laboratory tests performed in our

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