Acute myocarditis secondary to enteritis: A case report.

Unlabelled: Acute myocarditis is a rare complication of enteritis. Herein, we report the case of a 20-year-old man who presented with chest pain that developed three days after the onset of enteritis. Electrocardiogram, echocardiogram, and cardiac enzyme levels suggested myocarditis. Cardiac magnetic resonance imaging revealed a late gadolinium enhancement in the inferior wall. Degeneration and necrosis of myocardial cells and lymphocyte-dominant inflammatory cell infiltration were found in the tissue obtained by endomyocardial biopsy. Acute myocarditis associated with enteritis was confirmed by these findings and detected in the stool culture. The symptoms of enteritis and myocarditis remitted 10 days after the onset. The left ventricular ejection fraction was improved from 40 % to 57 %.In previous cases, endomyocardial biopsy has not been performed because of mild myocarditis. The lack of pathological reports makes the mechanism of myocarditis associated with enteritis unknown. We report a case of myocarditis associated with enteritis, which was diagnosed using cardiac magnetic resonance imaging and endomyocardial biopsy.

Learning Objective: Acute myocarditis is a rare but important complication of enteritis. Cardiac magnetic resonance imaging is useful for diagnosis. Most cases of myocarditis associated with enteritis were mild and remitted without specific treatment. In the present case, endomyocardial biopsy was performed and CD4-positive lymphocytes were predominantly detected in the myocardial tissue.