A rare case of concomitant viral myocarditis and pericarditis in a 44-year-old patient

Concomitant severe myocarditis and pericarditis are under-recognized or rare. We report a case of a 44-year-old woman who presented in shock after a week of a flu-like illness and several hours of severe back pain. Emergent echocardiography revealed cardiac tamponade for which pericardiocentesis achieved transient improvement. Unfortunately, the patient died 2 days later secondary to progressive cardiomyopathy and multi-system organ failure. Post-mortem studies of the heart were consistent with coxsackie virus myocarditis. Diagnosis and treatment of myocarditis and pericarditis are discussed, including clues to detecting concurrent disease processes.