Author/Authors :
McGee, Michael Cardiovascular Department - John Hunter Hospital, New Lambton Heights, NSW, Australia , Shiel, Emily Infectious Diseases Department - John Hunter Hospital, New Lambton Heights, NSW, Australia , Brienesse, Stephen Cardiovascular Department - John Hunter Hospital, New Lambton Heights, NSW, Australia , Murch, Stuart Cardiovascular Department - John Hunter Hospital, New Lambton Heights, NSW, Australia , Murch, Stuart Department of Medicine - University of Newcastle, Newcastle, NSW, Australia , Leitch, James Department of Medicine - University of Newcastle, Newcastle, NSW, Australia
Abstract :
Staphylococcus aureus myocarditis is a rare diagnosis with a high mortality rate, usually seen in people who are
immunocompromised. Here, we report a case of a 44-year-old man on methotrexate for rheumatoid arthritis who presented in
septic shock and was diagnosed with staphylococcus aureus myocarditis. The myocarditis was associated with a left ventricular
apical thrombus, with normal systolic function. The myocarditis and associated thrombus were characterised on transthoracic
echocardiogram and subsequently on cardiac magnetic resonance imaging. Cardiac magnetic resonance (CMR) imaging showed
oedema in the endomyocardium, consistent with acute myocarditis, associated with an apical mural thrombus. Repeat CMR 3
weeks following discharge from hospital showed marked improvement in endomyocardial oedema and complete resolution of
the apical mural thrombus. He was treated with a 12-week course of antibiotics and anticoagulated with apixaban. The patient
was successfully managed with intravenous antibiotics and anticoagulation with complete recovery
