Korean J Med.  2013 May;84(5):723-727.

Delayed-Onset Complete Atrioventricular Block in a Patient with Murine Typhus Myocarditis

• Kim BS
• Kim SY
• Han SH
• Park HK
• Lee DH
• Park JS

Abstract

Murine typhus is a flea-borne infectious disease caused by Rickettsia typhi, of which myocarditis is a rare complication in the acute disseminating phase. A 62-year-old female presented with a fever and was diagnosed with murine typhus. She was treated with doxycycline and discharged after complete resolution of the fever. However, recurrent presyncope and exertional dyspnea developed 6-8 weeks later. Complete atrioventricular (AV) block with a wide QRS escape rhythm and a left bundle branch block configuration was documented. Subacute myocarditis was diagnosed based on persistent cardiac troponin-I elevation and typical cardiac magnetic resonance imaging findings. A permanent pacemaker was implanted for symptomatic complete AV block. Few reports of myocarditis in murine typhus have been published. We report a case of murine typhus myocarditis complicated by complete AV block in the late convalescence phase.

Keyword

Rickettsia typhi; Myocarditis; Atrioventricular block

MeSH Terms

Atrioventricular Block
Bundle-Branch Block
Communicable Diseases
Convalescence
Doxycycline
Dyspnea
Female
Fever
Humans
Magnetic Resonance Imaging
Myocarditis
Rickettsia typhi
Syncope
Troponin I
Typhus, Endemic Flea-Borne
United Nations
Doxycycline
Troponin I