Peer Reviewed

Photoclinic

Shigellosis Presenting with Myocarditis

Monarch Shah, MD1 • Farrah Alarmanazi, MS42 • Aquib Gani, MS42

AFFILIATIONS:
1Resident Physician, Department of Internal Medicine, Saint Peter’s University Hospital, New Brunswick, NJ
2Medical Student, Department of Internal Medicine, Saint Peter’s University Hospital, New Brunswick, NJ

CITATION:
Shah M, Alarmanazi F, Gani A. Shigellosis presenting with myocarditis. Consultant. 2023;63(8):e3. doi:10.25270/con.2023.07.000002

Received April 27, 2022. Accepted January 17, 2023. Published online July 21, 2023.

DISCLOSURES:
The authors report no relevant financial relationships.

ACKNOWLEDGEMENTS
None.

CORRESPONDENCE:
Monarch Shah, MD, Department of Internal Medicine, Saint Peter’s University Hospital, 254 Easton Avenue, New Brunswick, NJ 08901 (monarch.shah08@gmail.com)



A 31-year-old woman presented to the emergency department with 3 days of nausea, vomiting, and abdominal pain, and 2 days of diarrhea. 

History. The vomitus consisted of food particles but did not contain blood. Her abdominal pain was cramping, non-radiating, constant, and without bloating, and would decrease after each episode of vomiting. She had four to five episodes of watery, non-bloody diarrhea for 2 days, which brought her to the hospital.

On the day of admission, she also noticed intermittent sharp left-sided chest pain that radiated to her neck and jaw which resolved within 15 minutes and did not recur. The pain was non-exertional and was unrelated to any physical activity. Upon admission, her vital signs included a temperature of 98.2˚ F, heart rate of 110 beats/min, blood pressure of 100/70 mm hg, respiratory rate of 14 breaths/min, and saturation of 98% on room air.

Her physical examination was within normal limits, including skin turgor and capillary refill. No murmur or collapsed neck vessels were observed. The patient had no significant medical history. There were no similar symptoms in her family members and she had no recent history of travel. She was born in Honduras but had been living in the United States for the past 10 years.

Diagnostic testing. Laboratory investigations showed neutrophil predominant leucocytosis of 17.6 x 103/mm3, a hemoglobin of 13.3 g/dl, and a platelet count of 24 x 103/mm3. Values for partial thromboplastin time, prothrombin time, international normalized ratio, and comprehensive metabolic panel were all within normal limits. Troponin was elevated at 0.730 ng/ml. An electrocardiogram (EKG) showed sinus rhythm within normal range with widespread ST depression, seen in leads I, II, and V5-6 with T wave flattening, and subtle ST elevation in V1 and aVR suggestive of subendocardial ischemia (Figure 1).