Nonrheumatic SPAM not uncommon in young men

Nonrheumatic streptococcal pharyngitis-associated myocarditis (SPAM) appears to occur more frequently than previously believed, particularly in young men presenting with sore throat and fever, suggests a recent study.

In this analysis, the authors evaluated the clinical course and outcome of 79 consecutive patients (mean age 32 years, 71 men) diagnosed with nonrheumatic SPAM, with a particular focus on differentiating it from other aetiologies of myocarditis. None of the participants met the revised Jones criteria for the diagnosis of acute rheumatic fever.

The average time to symptom onset before hospitalization was 5.44 days. All patients had sore throat and were treated with antibiotics for 10 days. Of these, 91 percent presented with chest pain, 90 percent had fever, 80 percent had electrocardiographic ST-segment elevation, and 100 percent had biochemical evidence of myocyte necrosis.

Twenty-seven patients underwent coronary angiography, and all were found to have either normal or nonsignificant coronary artery disease. Sixty-one individuals underwent cardiac magnetic resonance imaging, which showed subepicardial late gadolinium enhancement (90 percent) predominantly in the lateral (85 percent) and inferior (75 percent) sides.

“Nonrheumatic SPAM may not be as infrequent as thought and should be considered in the differential diagnosis of acute ST-segment elevation myocardial infarction, especially in young male patients with sore throat and fever,” the authors said.