Perimyocarditis. Report on an unusual cause.

Area of Science:

• Cardiology
• Infectious Diseases
• Virology

Background:

• Cytomegalovirus (CMV) infection, commonly known as CMV mononucleosis, can present with a wide range of clinical manifestations.
• While typically self-limiting, CMV can occasionally lead to severe complications affecting various organ systems, including the heart.

Observation:

• A 29-year-old male presented with febrile illness, chest pain, and tachycardia, initially suggestive of myocarditis or acute ischemia.
• Diagnostic workup revealed lymphocytosis, a small pericardial effusion on echocardiogram, and elevated liver enzymes (SGPT).
• A significant finding was a fourfold rise in IgM antibodies to CMV, confirming acute infection.

Findings:

• The patient was diagnosed with perimyocarditis, inflammation of the heart muscle and pericardium, secondary to CMV mononucleosis.
• A notable feature was an afebrile prodromal phase lasting over a week, characterized by prostration, palpitations, and exertional dyspnea with only tachycardia as a physical sign.
• Post-febrile phase findings included splenomegaly and elevated SGPT levels.

Implications:

• This case underscores CMV mononucleosis as a potential cause of perimyocarditis, a diagnosis that should be considered in patients with unexplained cardiac symptoms and lymphocytosis.
• The report emphasizes the importance of considering viral etiologies, particularly CMV, in the differential diagnosis of acute cardiac conditions.
• Detailed reporting of such cases contributes to a better understanding of the diverse clinical spectrum and potential cardiac sequelae of CMV infection.