Heart failure due to cytomegalovirus myocarditis in immunocompetent young adults: a case report

Abstract

BackgroundCardiac complications constitute a rare clinical manifestation of cytomegalovirus (CMV) infection. This virus is usually asymptomatic in immunocompetent individuals. We report a case of myocarditis and cardiac insufficiency due to primary CMV infection. Serological tests by using ELISA method showed positive results for the virus.Case presentationA 41-year-old man with no prior comorbidities presenting with dyspnoea, fever, and oedema was admitted to the cardiac emergency service. He had fever and dry cough, which aggravated into progressive respiratory distress, lower limb oedema, and orthopnoea 30 days prior to hospitalisation. The electrocardiogram revealed sinus tachycardia, first-degree right bundle branch block, and ventricular and left atrial overload as well as diffuse and nonspecific disturbances of ventricular repolarization. Serological tests were conducted, and IgM (1.54 UI/mL) and IgG (2.5 UI/mL) were found positive only for CMV by using ELISA. The patient was diagnosed with cardiac insufficiency due to CMV myocarditis. He was treated with ganciclovir for 10 days and received supportive medication.ConclusionThis case reaffirms the possibility of cardiac involvement in CMV infection and emphasises the importance of viral aetiologies as differential diagnoses for acute myocarditis.

Heart Dysfunction Following Long-Term Murine Cytomegalovirus Infection: Fibrosis, Hypertrophy, and Tachycardia

“…This correlates with other viral infections in humans, which also cause abnormal ventricular ejection (14). Both heart rate and hypertrophy results shown here mimic HCMV-induced myocarditis (18,24,27).…”

“…Despite the increased fibrosis at 50 dpi, the heart rate does not differ between time points in MCMVinfected hearts, suggesting that perhaps the initial damage caused by infection is enough to maintain the heart rate abnormality. This result mimics sinus tachycardia seen in humans during HCMV-induced myocarditis, which requires valganciclovir treatment to return the heart to normal function (18,24,27). These similarities between HCMV and MCMV further suggest that the murine model of cardiovascular dysfunction could reveal HCMV-associated cardiovascular complications.…”

“…In HCMV-seropositive individuals, studies have identified viral DNA and protein expression within the heart as well as detectable serum IgM and IgG (31). Acute HCMV infection can result in myocarditis with symptoms of sinus tachycardia, ventricular overload, and hypertrophy (18,24,27). Administration of the HCMV antiviral drug valganciclovir reduces complications associated with infection and returns the heart to normal function within 1 month of treatment (27).…”

Cytomegalovirus Reactivation in Critically Ill Patient: Cause or Consequence? A Case Report and Literature Review

“…Many cases of cardiovascular, haematological, hepatic and pulmonary disorders have been described [6,[8][9][10][11][12][13][14][15][16].…”

“…It frequently presents as an acute heart failure in previously healthy patient, often with alteration in intraventricular conduction with a right bundle branch block as a frequent alteration and complete recovery after support care [11][12][13].…”