Case Presentation: 72 years old Caucasian male presented to the hospital with the complaint of generalized maculopapular rash involving the chest and bilateral upper and lower extremities with the itching for the last 12 hours. He also had been having diarrhea for the last 2 days which was loose watery in consistency and yellowish in color and also having nausea along with that. He denied any sick contacts, recent antibiotic use, fevers, blood in the stool or tenesmus. He had a past medical history significant for aortic valve insufficiency and aneurysmal dilation of thoracic aorta s/p recent Bentall procedure for the aortic valve, aortic root and ascending aorta replacement along with reimplantation of the coronary arteries. He denied taking any new medications, trying new food, jewelry or clothing.The patient was hypotensive at the time of presentation and blood pressure improved with fluid resuscitation, IV steroids, and diphenhydramine. CBC was unremarkable and CMP showed AKI with a creatinine of 1.76(1.20 baseline). Troponin and EKG were unremarkable. The gastric pathogen panel was positive for Campylobacter jejuni. He was treated with supportive treatment. The patient developed pleuritic chest pain in the next 12 hours. Repeat troponin was elevated (2.87) with no changes in the EKG. Echocardiogram showed small-sized pericardial effusion with no wall motion abnormalities and stable ejection fraction. Chest pain was believed to be secondary to myopericarditis. He was started on colchicine and ibuprofen with which his symptoms improved.
Discussion: Campylobacter spp. are a common cause of mostly self-limiting enterocolitis. Although rare, pericarditis and myopericarditis have been increasingly documented as complications following campylobacteriosis. A dominant immune-mediated response seems less likely given the short window between the onset of enteric and cardiac symptoms, as distinct to that seen with C. jejuni and development of other immune-mediated diseases (e.g., Guillain–Barré syndrome and reactive arthritis) and may actually favour a toxin-mediated response. Antibiotics are not required this like in self-limited entero-colitis Clinical outcomes for C. jejuni (and C. coli) associated myopericarditis appear favourable with low rates of morbidity, mortality, evolution to heart failure and worsening ventricular function.
Conclusions: Although rare in incidence but infectious etiology of pericarditis should always be considered in a new diagnosis of pericarditis. C. jejuni can have acute complications of myopericarditis, urticaria, and cholecystitis which are treated supportively and have a favorable overall prognosis.