CHOLERA AND MYOCARDITIS - A CASE-REPORT

The authors describe the case of a fifty-nine-year-old white man, prev iously in good health, who initiated his present illness with acute ep isode of enterocolitis characterized by mild fever and, in the next ei ght hours, twenty-four episodes of watery diarrhea, nausea and vomitin g, as well as generalized sweating and severe weakness secondary to hy povolemia and electrolyte disorder. These complications were corrected in seventy-two hours in the intensive care unit. Two days later, when the patient was stable hemodynamically, under cardiac monitoring and with normal laboratory studies including serum electrolytes, he develo ped electrocardiographic changes characterized by trifascicular block (prolonged P-R interval, complete right bundle branch block [CRBBB] an d left posterior hemiblock [LPH]) with a cardiac rate of thirty beats per minute, for which a temporary pacemaker was inserted. Endomyocardi al biopsy showed histopathologic signs of myocarditis and the immunolo gic study of the cardiac tissue revealed positive polymerize chain rea ction (PCR+) with the presence of antitoxine choleric antibodies (AcTC A). After three weeks, the same conduction disturbances remained, for which a permanent pacemaker was inserted. On top of intravenous fluid replacement and electrolyte 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 presen t a rare and very well-documented myocarditis by cholera in a patient with enteric disease, in whom several cardiac complications occurred.