A curious case of Escherichia coli induced myocarditis

A 28-year-old man presented with central exertional pleuritic chest pain, associated with dyspnoea and reduced effort tolerance on the background of 1-week of upper respiratory tract infection like symptoms with recent overseas travel to Southeast Asia. Physical examination was unremarkable. Electrocardiogram showed sinus rhythm. Raised high-sensitivity troponin-T levels were noted. Transthoracic echocardiogram demonstrated normal ejection fraction and no regional wall motion abnormalities. Computer tomography (CT) coronary angiogram did not show obstructive coronary artery disease or structural abnormalities. The patient subsequently developed diarrhoea and abdominal discomfort localised to the right iliac fossa. Given this, intraabdominal imaging was performed and revealed features of ileocolitis. Stool Polymerase Chain Reaction testing detected Enteropathic Escherichia Coli. As no cause for raised troponins was found, a cardiac MRI was performed. On late gadolinium enhancement (LGE) imaging, there was subtle basal to mid septal midwall and inferolateral subepicardial uptake. LGE pattern and tissue characterisation parameters suggested recent episode of mild myocarditis. He was treated with a course of intravenous antibiotics with improvement of symptoms. Repeat cardiac MRI also demonstrated interval improvement 1 month after the acute event with only residual subtle subepicardial enhancement in the basal inferolateral wall.