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Pericarditis Associated with Campylobacter jejuni Enterocolitis

jejuni is one of the most common bacterial pathogens causing infectious entero-colitis. Cardiac complications related to this infection , however, including myocarditis and pericarditis, are extremely rare. This article describes the case of a 15-year-old boy who develops pericarditis associated with C. jejuni enterocolitis. A 15-year-old boy presented to a local rural outpatient clinic with 5 days of bloody diarrhea, cramping abdominal pain, dehydration, and malaise. He reported a recent trip to a resort in Florida, where he ate meals that included hamburgers and pork and drank water from water fountains. There was no medical history of any significant episodes of diarrhea in the past. The patient did have a few episodes of syncope 2 years prior to this presentation. The work-up at that time consisted of an echocar-diogram and tilt-table testing, both of which showed normal results. Physical examination showed an adolescent boy in no acute distress who was afebrile and had borderline tachycardia. Results of the head and neck examination were normal. The chest was clear to auscultation; heart sounds were normal without gallop, rub, or murmur. The abdominal examination showed diffuse tenderness , most pronounced in the right and left lower quadrants , without any rebound or guarding. Increased bowel sounds were noted. Rectal examination showed brown, watery stool that tested strongly guaiac-positive. The patient's leukocyte count was 7.8 × 10 3 /mm 3 (normal range, 4.8–10.8 × 10 3 /mm 3) with a left shift. The hemoglobin level was within normal limits. The patient was diagnosed with infectious diarrhea and was rehydrated with intravenous normal saline solution. He was sent home with instructions to continue oral hydration and gradually advance his diet. Stool cultures were taken, and no antibiotic therapy was given at that time. The following day, the patient presented to the hospital complaining of severe retrosternal chest pain radiating to his left shoulder. The pain was significantly worse when lying in a supine position and also was exacerbated by coughing and deep inspiration. The patient did not complain of shortness of breath. His pain was very severe in the upright position, with its intensity rated 6/10 by the patient, increasing to 9/10 during attempts to be supine. He denied having used any illegal stimulants. On physical examination, patient appeared ill; he was in obvious pain and was very reluctant to lie down. His blood pressure was 95/59 mm Hg. There was no pulsus paradoxus …