Active myocarditis in a patient with chronic active Epstein-Barr virus infection

Area of Science:

• Cardiology
• Infectious Diseases
• Virology

Background:

• Chronic active Epstein-Barr virus (CAEBV) infection presents with persistent or relapsing mononucleosis-like symptoms.
• Prognosis for CAEBV is generally poor, with potential for severe complications.
• Heart failure as an initial symptom of Epstein-Barr virus (EBV) infection, specifically chronic active myocarditis, is unusual but critical to recognize.

Discussion:

• This case highlights a 45-year-old male with a 5-year history of CAEBV infection presenting with moderate left ventricular systolic dysfunction and pericardial effusion.
• Endomyocardial biopsies revealed significant lymphocytic infiltration, myocytolysis, and necrosis, indicative of active myocarditis.
• Immunohistology confirmed T lymphocytes as the predominant infiltrating cells, with some positive for EBV-encoded small nuclear RNA via in situ hybridization.

Key Insights:

• The study demonstrates the potential for CAEBV to cause chronic active myocarditis, leading to significant cardiac impairment.
• Positron emission tomography with (18)F-fluoro-2-deoxyglucose ((18)F-FDG) showed increased metabolic activity in the left ventricular wall, consistent with active inflammation.
• The findings underscore the importance of considering CAEBV in the differential diagnosis of unexplained heart failure, particularly in patients with a history of EBV infection.

Outlook:

• Further research is needed to elucidate the precise mechanisms by which EBV induces chronic active myocarditis.
• Developing targeted therapies for CAEBV-associated myocarditis could improve patient outcomes and prevent disease progression.
• Enhanced diagnostic strategies are required for earlier identification of cardiac involvement in CAEBV patients.