A case of coxsackie B virus infection leading to multi-organ inflammation: Myopericarditis and acute liver failure

Abstract

Myopericarditis refers to the development of acute pericarditis with myocardial involvement. Viral infections, including Coxsackie B virus, are amongst the most common causes of myopericarditis. The Coxsackie B viruses are known to have a role in the development of a number of clinical diseases including but not limited to cardiac disease, central nervous system infections, ocular infections, pleurodynia, gastrointestinal disease, and viral exanthems. In individual cases, Coxsackie B virus may also be associated with acute hepatitis. We describe a rare case of a 41 year-old female with multi-organ inflammation caused by Coxsackie B virus leading to myopericarditis, pleuritis, and acute liver failure. Laboratory and imaging data helped to make diagnosis of myopericarditis and appropriate management was initiated. Shortly after the patient developed acute liver failure with an INR greater than 13 and AST and ALT of 7946 u/L and 5684 u/L, respectively. Viral serology revealed Coxsackie B 1, 2, and 6 serum antibody positivity (> 1:32 titer) indicating acute or recent infection. A complete workup for other liver failure etiologies was negative. The case shows the significance of awareness and recognition of the possible complications of Coxsackie B virus infection including liver failure.

Coxsackie B2 Virus Infection Causing Multiorgan Failure and Cardiogenic Shock in a 42-Year-Old Man

“…4 Another patient had myopericarditis, pleuritis, and acute liver failure caused by CVB, with elevated titers of serotypes CVB1, -2, and -6. 16 Our patient's case is unusual not only because of the organ systems involved, but also the complex sequence of organ involvement, from pancreas and spleen to kidneys and heart. Although some of the earlier patients also had substantial disease processes (particularly in compromised hosts, unlike our patient), aggressive intervention ultimately enabled their recovery.…”

Effusive-constrictive pericarditis, hepatitis, and pancreatitis in a patient with possible coxsackievirus B infection: a case report

“…To the best of our knowledge, this is the only case report of a patient with concomitant effusive-constrictive pericarditis, hepatitis and pancreatitis described in the medical literature. Coxsackie B 1, 2, and 6 group serotypes can be associated with complicated disease with left ventricular dysfunction and myocardial infarction from myopericarditis and acute liver failure from hepatitis [ 4 , 5 , 15 ]. Diagnosis is largely based on clinical manifestations of disease with positive serological tests.…”

“…In the acute setting of her rising, positive antibody titers and clinical presentation of disease, we believe that our patient acquired coxsackievirus B from her sick, younger sister. Serological markers for coxsackie B virus have been associated with the development of myocarditis and pericarditis [ 5 ]. The combination of myocarditis, hepatitis and pancreatitis due to coxsackie B infection is very rare.…”

“…Only one of the prior published cases reported a presentation of isolated effusive-constrictive pericarditis by coxsackie A4 and B3 [ 13 ]. There are few case reports on hepatitis associated with coxsackie virus infection [ 5 , 7 , 8 ]. In a retrospective study of 602 patients with acute pancreatitis, 22.1 % of cases were probably attributed to coxsackie viral infection [ 11 ].…”

“…Viral pericarditis is inflammation of the pericardium or the lining surrounding the heart that is caused by viral infections [ 2 ]. Coxsackie B viruses are the most common cause of myocarditis and pericarditis in adults and have been identified in up to 50 % of viral cardiac cases [ 3 – 5 ]. A number of other viral, bacterial, and fungal infections as well as medications has also been shown to cause myocarditis and pericarditis [ 2 , 6 ].…”