Fatal Cytomegalovirus Disease in a Previously Healthy Adult

Waris, E; Räsänen, O; Kreus, K.‐E.; R, Kreus

doi:10.3109/inf.1972.4.issue-1.13

Cited by 26 publications

(11 citation statements)

References 14 publications

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“…8,11 On the other hand, 4 of 16 patients with CMV myocarditis who had multiorgan involvement did not receive antiviral therapy and died. 1,4 Even though half of the cases of CMV infection in an immunocompetent host are mild and self-limiting (with complete recovery), the benefits of valganciclovir therapy might outweigh the risks when one considers the high mortality rate in patients with fulminant myocarditis, severe myocardial dysfunction, and multiorgan involvement.…”

Section: Discussionmentioning

confidence: 99%

“…1,4,8,11 If the CMV infection is associated with pericarditis, patients might also report pleuritic chest pain and manifest pericardial friction rub on auscultation, diffuse ST elevations on ECG, and pericardial effusion on echocardiography. 6,7,9,10,13 Classically, a prolonged viral prodrome is typical before the development of cardiac symptoms, as seen in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…A comprehensive review of the English-language medical literature yielded 16 reported cases of CMV myocarditis in immunocompetent individuals, [3][4][5][6][7][8][9][10][11][12][13] including our case and 4 cases from the review by Eddleston and colleagues.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Cardiovascular magnetic resonance (CMR) has emerged as a valuable noninvasive tool in diagnosing myocarditis with 76% sensitivity, 95.5% specificity, and 85% accuracy. 17 Neither endomyocardial biopsy nor CMR was performed in our patient, because she experienced expedited clinical improvement of her heart-failure symptoms and echocardiographic resolution of her left ventricular dysfunction with valganciclovir therapy.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, CMV myocarditis and pericarditis in an immunocompetent host are extremely rare entities: few cases have been reported to date. [3][4][5][6][7][8][9][10][11][12][13] It is quite possible that the true number of CMV myocarditis cases is underreported, because most cases are self limiting and underdiagnosed. …”

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confidence: 99%

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Fulminant Cytomegalovirus Myocarditis in an Immunocompetent Host: Resolution with Oral Valganciclovir

Padala

Kumar

Padala

2014

Texas Heart Institute Journal

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W e present a rare case of fulminant myocarditis caused by a cytomegalovirus (CMV) infection in an immunocompetent patient-an infection that oral valganciclovir therapy resolved in a dramatic clinical and immunologic manner. Cytomegalovirus infection occurs primarily in the setting of advanced immunosuppression (for example, among human immunodeficiency virus [HIV] patients and organ-transplant recipients) and is typically a reactivation of latent infection. Cytomegalovirus infection in an immunocompetent host is generally asymptomatic; or it might present as a mild, self-limiting, heterophile-negative, mononucleosis-like syndrome. Occasionally, primary CMV infection in immunocompetent hosts can lead to severe organ-specific complications, significant morbidity, and death.1 In a 2008 review 2 of the medical literature, which examined 290 immunocompetent adults with severe CMV infection, the most frequent sites involved were the gastrointestinal tract (colitis) and the central nervous system (meningitis, encephalitis, and transverse myelitis), followed by the blood (hemolytic anemia and thrombocytopenia), the arterial or venous system (thrombosis), the eyes (uveitis), and the lungs (pneumonitis). In contrast, CMV myocarditis and pericarditis in an immunocompetent host are extremely rare entities: few cases have been reported to date. [3][4][5][6][7][8][9][10][11][12][13] It is quite possible that the true number of CMV myocarditis cases is underreported, because most cases are self limiting and underdiagnosed. Case ReportIn January 2013, a 72-year-old previously healthy white woman was hospitalized for high-grade fevers (2-week history) unresponsive to acetaminophen and for profound weakness, myalgia, headaches, and poor oral intake. She reported no recent contact with sick people or animals, no recent history of travel, no history of blood-product transfusion, and no smoking, alcohol, or recreational drug use. Her medical history was significant for hypothyroidism treated with levothyroxine. Examination at presentation was unexceptional apart from high-grade fevers up to 104 °F.Her initial laboratory studies showed a white blood cell count of 7.6 ×10 3 /µL (normal range, 4-11 ×10 3 /µL) with a lymphocyte count of 66% (normal range, 20%-53%). Her C-reactive protein level was 11 mg/dL (normal, ≤0.49 mg/dL). Her liver enzymes on admission were elevated: alkaline phosphatase, 201 U/L (normal range, 20-140 U/L); aspartate aminotransferase, 171 U/L (normal range, 5-40 U/L); and alanine aminotransferase, 162 U/L (normal range, 5-40 U/L). Her bilirubin lev-

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Fulminant Cytomegalovirus Myocarditis in an Immunocompetent Host: Resolution with Oral Valganciclovir

Padala

Kumar

Padala

2014

Texas Heart Institute Journal

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Fatal Disseminated Cytomegalovirus Infection in an Apparently Normal Adult

et al. 1983

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Low molecular weight IgM in cytomegalovirus infections and cardiac patients

Nagington¹,

Smith²,

Cranage

1982

Journal of Medical Virology

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When 71 ischaemic heart disease and cardiomyopathy patients' sera were examined by the IFA (indirect fluorescent antibody) test, 18 of the 49 (36%) with CMV (cytomegalovirus) CF antibody appeared to contain a specific LMW (7S approx) IGM. This IgM was unrelated to the presence of RF (rheumatoid factor) demonstrable by agglutination of IgG-coated latex and by an immunofluorescence test, was not absorbed by heat-aggregated IgG and latex, nor did its demonstration appear to be complement dependent. It was demonstrable in acute CMV infection and in some cardiac patients, binds to HSV (herpes simplex virus) and CMV-infected cells.

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Fatal Cytomegalovirus Disease in a Previously Healthy Adult

Cited by 26 publications

References 14 publications

Fulminant Cytomegalovirus Myocarditis in an Immunocompetent Host: Resolution with Oral Valganciclovir

Fulminant Cytomegalovirus Myocarditis in an Immunocompetent Host: Resolution with Oral Valganciclovir

Fatal Disseminated Cytomegalovirus Infection in an Apparently Normal Adult

Low molecular weight IgM in cytomegalovirus infections and cardiac patients

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