The current study has the following limitations: 1)the study population was small; 2) no children, immunosuppressed patients, or patients with episodes of recurrent tonsillitis were included; 3) myocardial biopsy data were available for only a few patients;and 4) long-term follow-up data were not available. In conclusion, acute streptococcal tonsillitis can be complicated by acute streptococcal myocarditis,with either a typical or an atypical presentation, that can occasionally contribute to left ventricular dysfunction.
Cardiac MRI is essential in the diagnosis of the different forms of this type of myocarditis and allows noninvasive follow-up.