• Wesam Mulla, Anan Younis, Sana Zahalka, Anat Wieder, Dafna Yahav, Amitai Segev, Israel Mazin, Raphael Kuperstein, Michael Arad, Shlomi Matetzky, and Roy Beigel.
• Division of Cardiology, Sheba Medical Center, Ramat Gan, Israel; Division of Internal Medicine, Sheba Medical Center, Ramat Gan, Israel. Electronic address: wesam.mulla@sheba.health.gov.il.
• Am. J. Med. 2025 Jan 22.

BackgroundReports of nonrheumatic streptococcal pharyngitis associated myocarditis (SPAM) are rare, and its incidence, pathophysiology, and clinical features remain unclear. We evaluated the clinical course and outcome of patients diagnosed with nonrheumatic SPAM, with a particular focus on differentiating it from other etiologies of myocarditis.MethodsSeventy-nine consecutive individuals (age 32±9 years, 71 men) with clinically diagnosed SPAM were evaluated. None satisfied the revised Jones criteria for diagnosis of acute rheumatic fever.ResultsAverage onset of symptoms prior to hospitalization was 5.44±5.16 days, all had sore throat and were treated with antibiotics for 10 days; Clinical presentation consisted mostly with chest pain (91%), fever (90%), electrocardiographic ST-segment elevation (80%), and biochemical evidence of myocyte necrosis (100%). In 27 cases, coronary angiography was performed and in all either normal or nonsignificant coronary artery disease was found. Cardiac magnetic resonance imaging was done in 61 cases and demonstrated subepicardial late gadolinium enhancement (90%) predominantly in the lateral (85%) and inferior (75%) sides.ConclusionsNonrheumatic 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 male patients with sore throat and fever.Copyright © 2025. Published by Elsevier Inc.

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