EXTREMELY RARE CASE OF YERSINIA ENTEROCOLITICA PERIMYOCARDITIS IN A YOUNG ADULT

It is generally known that both myocarditis and pericarditis are usually caused by cardiotropic viruses. Thus the cardiac complications are rarely, but repeatedly, described in association with bacteria such as Salmonella, Shigella, and Campylobacter. We report a rare case where a young adult with no past history of any medical illnesses developed perimyocarditis related to Yersinia enterocolitica serotype 0:3. As far as we know, this is the first reported case in the Czech Republic. Furthermore, the last case of perimyocarditis in association with that agent was reported 17 years ago and was presented in Germany in 1992. Since 1978, only 5 studies dealing with Yersinia enterocolitica carditis have been developed.
Upon admission to our institution, transient pericardial friction rub was audible. ECG showed diffuse ST-elevation. Increased cTnI (8.78 ug/l) and CRP levels (82 mg/mL) accompanied with elevated blood cell count (10.4 x 10 9/L) were also observed. A transthoracic echocardiography (TTE) revealed a mild left ventricular hypokinesis. Anti- Yersinia enterocolitica serotype 0:3 antibodies were detected and treatment with Cotrimoxazol was initiated. The IgM value was 112, IgG and IgE were ‹10. The patient was discharged from the hospital in a haemodynamically stable condition after 9 days of treatment. Clinical and laboratory follow-up was performed 14 days after hospital discharge. The convalescent serology for Yersinia enterocolitica serotype 0:3 demonstrated conversion to positive IgG for Yersinia, as the IgG value was ›1000, IgM 116.8 and IgA ›50. TTE showed no remarkable changes compared to the previous examination. CRP value decreased to 1.7 mg/l as well as the white blood cell count- 6.3 x10^9/l, the cTnI was < 0.03 ug/l.