Cholera and Myocarditis: A Case Report

• Published in: Angiology 1997-06, Vol.48 (6), p.545-549
• Main Authors: Leon, Francisco, Badui, Elias, Campos, Arturo, Enciso, Roberto, Fakih, Tarek, Guadarrama, Maria, Valdespino, Aquiles, Murillo, Hector, Calleja, Consuelo
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibodies, Bacterial - analysis; Bacterial diseases; Biological and medical sciences; Bradycardia - etiology; Bundle-Branch Block - etiology; Cholera; Cholera - complications; Cholera - drug therapy; Cholera - physiopathology; Diarrhea - physiopathology; Electrocardiography; Enterocolitis - physiopathology; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Myocarditis - drug therapy; Myocarditis - etiology; Nausea - physiopathology; Pacemaker, Artificial; Polymerase Chain Reaction; Sweating - physiology; Tetracycline - therapeutic use; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Tropical bacterial diseases; Tropical medicine; Vibrio cholerae - genetics; Vibrio cholerae - immunology; Vomiting - physiopathology
• ISSN: 0003-3197; 1940-1574
• DOI: 10.1177/000331979704800610

The authors describe the case of a fifty-nine-year-old white man, previously in good health, who initiated his present illness with acute episode of enterocolitis characterized by mild fever and, in the next eight hours, twenty-four episodes of watery diarrhea, nausea and vomiting, as well as generalized sweating and severe weakness secondary to hypovolemia and electrolyte disorder. These complications were corrected in seventy- two hours in the intensive care unit. Two days later, when the patient was stable hemo- dynamically, under cardiac monitoring and with normal laboratory studies including serum electrolytes, he developed electrocardiographic changes characterized by trifasci cular block (prolonged P-R interval, complete right bundle branch block [CRBBB] and left posterior hemiblock [LPH]) with a cardiac rate of thirty beats per minute, for which a temporary pacemaker was inserted. Endomyocardial biopsy showed histopathologic signs of myocarditis and the immunologic study of the cardiac tissue revealed positive poly merize chain reaction (PCR+) with the presence of antitoxine choleric antibodies (AcTCA). After three weeks, the same conduction disturbances remained, for which a permanent pacemaker was inserted. On top of intravenous fluid replacement and elec trolyte supplements, the patient was managed with tetracycline 2 g a day for one week and sulfamethoxazole-trimethoprim 800/160 mg a day for two weeks. The purpose of this study is to present a rare and very well-documented myocarditis by cholera in a patient with enteric disease, in whom several cardiac complications occurred.