A Rare Case of Cardiac Recovery after Acute Myocarditis from West Nile Virus Infection: A Review of the Current Literature

Abstract

West Nile Virus (WNV) myocarditis is nearly fatal, according to the current medical literature. We report a previously healthy 37-year-old Caucasian male who presented to our facility with two days of progressive lower extremity weakness, fever, edema, and shortness of breath found to have left ventricular global hypokinesis with an ejection fraction of less than 25%, consistent with acute viral myocarditis. He also has concomitant WNV meningoencephalitis due to his altered mentation. He was found to have a positive serum WNV IgM suggestive of a diagnosis of WNV myocarditis. He was intubated and was placed on vasoactive pressors for supportive care due to evidence of mixed cardiogenic and septic shock. After two weeks of hemodynamic support, we discovered a near-complete cardiac recovery, as shown on a repeat transthoracic echocardiography (TTE) and a normalized mean arterial blood pressure. This is a unique case report because near fatality is often associated with WNV myocarditis secondary to tachyarrhythmia, and there are currently no documented cases that are suggestive of cardiac recovery from the current literature.

A Review on The Pathogenesis of Cardiovascular Disease of Flaviviridea Viruses Infection

“…While initial human cases connecting WNV to myocarditis or cardiomyopathy were sparse, the surge in WNV infections has highlighted its ability to cause myocardial damage in humans as well. WNV infection has been associated with serious cardiac conditions, including fatal arrhythmias, myocardial dysfunction, elevated cardiac enzymes, ventricular tachycardia, ventricular fibrillation, and heart block [ 88 ]. In support of this, one study revealed evidence of myocardial damage in patients with WNV infection, characterized by elevated myocardial enzyme levels and electrocardiogram ST segment changes, indicating cardiac dysfunction.…”

Advancing Precision Medicine in Myocarditis: Current Status and Future Perspectives in Endomyocardial Biopsy-Based Diagnostics and Therapeutic Approaches

“…Other RNA viruses, excluding enteroviruses, found globally and associated with myocarditis include influenza A and B viruses, measles and rubella viruses, respiratory syncytial virus, parainfluenza virus, hepatitis C and E viruses, and human immunodeficiency virus [141,[178][179][180][181][182][183][184][185][186][187]. Finally, vector-borne infections caused by chikungunya, dengue, Zika, and West Nile viruses, have been associated with myocarditis [188][189][190][191][192][193][194][195][196]. These cases are rare, but should not be neglected, considering that 3.5 billion people live in areas where these viruses are endemic.…”