CaseReport Separating Acute Rheumatic Fever from Nonrheumatic Streptococcal Myocarditis LaithA.Derbas , 1 Anweshan Samanta, 1 Srinivasa Potla, 1 Moustafa Younis, 1 Laura M. Schmidt, 1,2 andIbrahimM.Saeed 1,2 1 Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA 2 Mid America Heart Institute, Saint Luke’s Hospital, Kansas City, MO, USA Correspondence should be addressed to Ibrahim M. Saeed; isaeed@saint-lukes.org Received 24 October 2018; Accepted 12 December 2018; Published 16 January 2019 Academic Editor: Alexander Bauer Copyright © 2019 Laith A. Derbas et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Streptococcal pharyngitis has been historically complicated with systemic involvement manifesting as acute rheumatic fever, which is a serious condition that can lead to permanent damage to heart valves. A recent association between streptococcal pharyngitis and nonrheumatic heart disease is emerging in literature. We present a case of nonrheumatic streptococcal myocarditis diagnosed using cardiac MRI. CasePresentation. A 25-year-old male, presented with complaints of sore throat, nonproductive cough, fever, pleuritic chest pain, and progressive dyspnea for four days. e patient had elevated troponins at presentation of 0.47 (ng/L) that peaked at 4.0 (ng/L). ECG showed sinus rhythm and STelevations in leads V2, V3, V4, and V5. NT-Pro-BNP was 1740. Transthoracic echocardiogram (TTE) showed reduced ejection fraction (EF) of 37% and global hypokinesis. e rapid strep test was positive for group A streptococcus and C-reactive protein was elevated at 161. Cardiac MRI demonstrated an EF of 53% and edema in the anterior wall without delayed gadolinium enhancement. Cardiac catheterization showed normal coronaries. Discussion. According to modified Jones criteria, the patient did not meet the full major or minor criteria to be diagnosed with acute rheumatic fever. e course of the nonrheumatic myocarditis is favorable and includes a full recovery of cardiac function, no involvement of cardiac valves, or long-term use of antibiotics. Conclusion. It is crucial to make a separate distinction between acute rheumatic fever and nonrheumatic myocarditis because this will have huge implications on management and long-term use of antibiotics. Cardiac imaging modalities can aid in distinction between the two disease entities. 1.Introduction Streptococcal pharyngitis is often associated with systemic involvement manifesting as acute rheumatic fever. is can result in damage to all three layers of the heart, the epi- cardium, myocardium, and endocardium, in a spectrum of disease traditionally known as rheumatic heart disease [1]. Recent reports indicate the presence of an association be- tween streptococcal pharyngitis and myocarditis, which appears to fall outside of the realm of rheumatic fever and rheumatic heart disease [2–6]. is distinct association between streptococcal throat infection and cardiac in- volvement could broaden our current understanding of cardiac pathology beyond the purview of acute rheumatic fever. We present a case of nonrheumatic streptococcal myocarditis diagnosed with the assist of cardiac MRI. 2.ClinicalCourse A 25-year-old man presented to the hospital with a 4-day history of pleuritic chest pain and progressive dyspnea. He had a sore throat, nonproductive cough, and fever over the same duration of time. His ECG showed sinus rhythm with ST elevations in leads V2, V3, V4, and V5 (Figure 1). Serial troponins showed an upward trend with a peak of 4.0 (ng/L). NT-pro-BNP was 1740 on presentation. Cardiac catheteri- zation showed normal coronary anatomy. A TTE on the same day showed a reduced ejection fraction of 37% with Hindawi Case Reports in Medicine Volume 2019, Article ID 4674875, 3 pages https://doi.org/10.1155/2019/4674875