Myocarditis Triggered by Erysipelas

• Published in: JACC. Case reports Vol. 30; no. 21; p. 104441
• Main Authors: Wosgien, Katharina, O h-Ici, Darach
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 30.07.2025
• Subjects: blood tests; cardiac magnetic resonance; Cardiovascular; chest pain; complication; fibrosis; imaging; left ventricle; necrosis; CRP; complication; chest pain; left ventricle; necrosis; SCD; blood tests; CMR; fibrosis; cardiac magnetic resonance; imaging; ASO; C-reactive protein; cardiac magnetic resonance imaging; sudden cardiac death; antistreptolysin O
• ISSN: 2666-0849; 2666-0849
• DOI: 10.1016/j.jaccas.2025.104441

Myocarditis is an inflammatory disease of the myocardium often triggered by viral infections. However, bacterial causes, such as group A β-hemolytic Streptococcus, are less common but clinically significant. A 26-year-old man presented with acute chest pain after erysipelas of the right foot. Electrocardiography revealed unspecific ST-segment elevations. Cardiac biomarkers were elevated, and transthoracic echocardiography showed global hypokinesia with a reduced ejection fraction. Cardiac magnetic resonance imaging confirmed myocarditis. Elevated antistreptolysin O titers indicated a recent streptococcal infection. The patient recovered fully after 7 days of intravenous antibiotics. This case highlights toxin-mediated myocarditis secondary to erysipelas, a rare but significant clinical entity. The body of evidence on nonrheumatic bacterial myocarditis underscores the importance of early recognition and appropriate imaging. Streptococcal infections can cause myocarditis through toxin-mediated mechanisms. Cardiac magnetic resonance imaging is essential for diagnosing myocarditis and guiding management. [Display omitted]