Related Experiment Videos
Varicella myocarditis in an adult
1Department of Internal Medicine-Cardiology, Philipps-University of Marburg, Baldingerstrabetae, D-35033 Marburg/Lahn, Germany. alter@mailer.uni-marburg.de
Insights
Varicella infection can cause myocarditis in adults, presenting with chest pain and fever. Early diagnosis and treatment of this rare cardiac complication can lead to complete recovery.
Area of Science:
- Cardiology
- Infectious Diseases
- Virology
Background:
- Varicella-zoster virus (VZV) infection, commonly known as chickenpox, is typically a mild childhood illness.
- However, VZV can cause severe complications in adults, including myocarditis, a rare inflammation of the heart muscle.
Observation:
- A 24-year-old male presented with chest pain and fever, diagnosed with varicella myocarditis.
- Electrocardiogram (ECG) revealed ST elevation and T wave abnormalities, indicative of cardiac injury.
- Elevated cardiac biomarkers (creatine kinase, troponin I, lactate dehydrogenase), left ventricular dilation, and reduced ejection fraction were observed.
- Endomyocardial biopsy confirmed the diagnosis of myocarditis.
Findings:
- The patient received treatment with varicella hyperimmunoglobulins, aciclovir, and non-steroidal anti-inflammatory drugs.
- Complete recovery was observed within two months of follow-up.
Implications:
- This case highlights that varicella infection can manifest as myocarditis in adults, a potentially serious cardiac complication.
- Prompt diagnosis and appropriate antiviral and supportive therapy are crucial for favorable outcomes in varicella-induced myocarditis.
- Increased awareness among clinicians regarding adult VZV complications is warranted.
Abstract:
A 24 year old male with varicella myocarditis was admitted with chest pain and fever up to 39 degrees C. The ECG showed J point and ST elevation in leads V2-V4, and inverted T waves in leads V5 and V6. Creatine kinase (CK) was raised to 435 U/l (CK-MB 36 U/l), troponin I was 63.4 microgram/l, and lactate dehydrogenase was 359 U/l, suggesting cardiac involvement of varicella infection. The left ventricle was dilated (58 mm) and left ventricular ejection fraction was globally reduced (ejection fraction 45%). Myocarditis was confirmed by endomyocardial biopsy. The patient was treated with specific varicella hyperimmunoglobulins, aciclovir, and a non-steroidal anti-inflammatory drug. During two months follow up the patient recovered completely. This case report is a reminder that a varicella infection can cause myocarditis in adults. Early diagnosis and appropriate treatment of this rare form of myocarditis may lead to complete recovery.