Quick Fire Cases
Roshni S. Kalkur, MD
Resident Physician
Dartmouth Hitchcock Medical Center
Roshni S. Kalkur, MD
Resident Physician
Dartmouth Hitchcock Medical Center
Kelli Brush, MD
Resident Physician
Dartmouth Hitchcock Medical Center
Kajal Shah, MD
Cardiology Fellow
Dartmouth
Nicholas Chan, MD
Cardiology Fellow
Dartmouth Hitchcock Medical Center
Hanyuan Shi, MD
Cardiac Imaging Fellow
University of Pennsylvania
Katharine A. Manning, MD
Advanced Heart Failure Attending Physician
Dartmouth Hitchcock Medical Center
Armin Helisch, MD
Attending Physician
Dartmouth Hitchcock Medical Center
A 19-year-old male with a past medical history of asthma presented with a 3-day history of sharp chest pain, shortness of breath, fever, and intermittent palpitations. He also reported a 6-month history of productive cough treated with inhalers. EKG demonstrated lateral ST elevations (Fig 1). Labs were notable for a high-sensitivity troponin of 1027 and proBNP of 794. Chest x-ray was notable for bilateral pneumonia. Viral panel was positive for Mycoplasma Pneumoniae.
Diagnostic Techniques and Their Most Important Findings: TTE demonstrated an ejection fraction of 45% with hypokinesis of the inferior and lateral wall segments along with a trivial pericardial effusion. A cardiac MRI was obtained which demonstrated mild LV dilation with LVEF of 38%, normal RV size with mildly reduced systolic function, and epicardial mid-distal lateral wall enhancement consistent with myocarditis (Fig 2). The patient was seen by Infectious Disease and treated with azithromycin in addition to high-dose aspirin. Cardiac catheterization was deferred due to low probability of coronary artery disease. He was started on guideline-directed medical therapy for his reduced LVEF with metoprolol succinate and losartan. He did not require diuresis as he remained euvolemic. He was advised to avoid competitive sports and exercise for at least three months.
Learning Points from this Case: Cardiac complications associated with M. pneumoniae infection are relatively uncommon with an incidence ranging from 1% to 5%. There are few reported cases of M. Pneumoniae myopericarditis, and moderate to severe reduction in LVEF function is more commonly seen in older, immune-compromised patients. Presenting symptoms can be vague, therefore necessitating broad infectious testing and advanced imaging techniques. Adequate treatment with macrolides often leads to complete resolution of symptoms and cardiomyopathy, emphasizing the importance of timely recognition and treatment.
