Carditis as unrecognized extra-pulmonary complication of Mycoplasma pneumoniae infection in adults: a case report

A 44 years old man admitted to the hospital with fever and sudden onset of severe oppressive chest pain localized in the left breast area, radiating to the left arm. Examination revealed blood pressure 120/80 mm Hg, respiratory rate 18/min, heart pulse rate 100 beats/min, oxygen saturation (SpO2) of 96—98 % on room air, flatness to percussion and presence of inspiratory crackles in the left basal area. EKG showed sinus tachycardia and non-specific alteration of repolarization in the anterolateral area of left ventricle. Troponin I and CK-MB, CRP and erythrosedimentation rate were considerably elevated. Chest radiograph performed at the admission revealed left basal consolidation with an effusion, suggesting pneumonia. On the basis of this data atypical pneumonia with cardiac complication was suspected and serum titers for respiratory viruses and atypical microorganism was performed. Antibodies (IgM) to M. pneumoniae were positive with high titer. Cardiac MRI was performed and showed tissue edema areas and multiple «late enhancement» myocardial areas on the anterolateral wall of left ventricle. Pneumonia and carditis due to Mycoplasma pneumoniae were successfully treated with clarithromycin 500 mg twice daily and ceftriaxone 2 g one daily for fifteen days.