A Rare Case of Non-rheumatic Streptococcal Acute Myocarditis

Non-rheumatic Streptococcal Acute Myocarditis, also known as Strep Pharyngitis Acute Myocarditis (SPAM) occurs in young adults, typically within five days of the initial streptococcal pharyngitis, and is characterized by typical cardiac symptoms, abnormal electrocardiography, and elevated cardiac biomarkers in the absence of obstructive coronary artery disease. Patients may also report myalgias, arthralgias, and constitutional symptoms. Although a rare complication of Group A and G streptococcal infections, prompt recognition is important to ensure appropriate management.

Myocarditis

A previously healthy 33 years old male presented to the emergency department after awakening with sub-sternal chest pain and tightness radiating to his left arm. Associated symptoms included nausea, dyspnea and pain in his left knee.Two days previously he had been evaluated at a local urgent care for a sore throat and was started on oral amoxicillin based on a positive rapid strep A test; his sore throat had resolved.On examination, vital signs were stable. Heart was regular rate and rhythm without murmurs, rubs or gallops. Lungs were clear to auscultation. The left knee exam was benign, without effusions, erythema or increased warmth.

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