Monkeypox-Associated Pericarditis: A Maiden Case

Abstract

One of the most prevalent causes of pericarditis has been identified as virus infection. However, very little is known regarding cardiac involvement as a consequence of monkeypox infection. We describe a rare case of pericarditis with mild pericardial effusion in an immunocompetent adult with a one-week history of monkeypox. To the best of our knowledge, not many case reports are available in the existing literature. This might be the among the first few cases of monkeypox associated pericarditis during the current pandemic. The use of nonsteroidal anti-inflammatory medications, and colchicine to manage pericarditis has been the cornerstone of the therapy. Within two weeks, the patient reported improvement in his symptoms and the resolution of the pericardial effusion.

Monkeypox-Induced Myocarditis: A Systematic Review

“…Further, 9 studies were removed as the patients enrolled were either not positive for monkeypox or there was no conclusive evidence for myo/pericarditis based on lab and imaging findings. Hence, a total of 6 studies 6 , 7 , 13 , 14 , 15 , 16 were included in the review, of which 4 are case reports, and 2 are case series ( Supplementary Figure 1 ).…”

“…It is classically transmitted by contact with respiratory droplets, body fluids, and the skin of an infected patient and presents with fatigue, fever, muscle ache, backache, headache, rash, and lymphadenopathy. Antiviral therapy for smallpox may help slow the spread of monkeypox, but there is currently no specific treatment for monkeypox, as confirmed by the Centre for Disease Control (CDC) 1 , 6 . It remains unknown whether vaccines against smallpox will be efficient for controlling monkeypox 5 .…”

“…Adding to the turmoil, various complications have been identified, including inflammatory conditions like myocarditis and pericarditis 6 , 7 . A rise in cardiac biomarkers associated with the symptoms of chest pain was observed in the case reports described for monkeypox-induced myocarditis.…”

“…Lymphocytic inflammation followed by myonecrosis is the most common pathophysiology in viral myocarditis, although the specifics of the pathophysiology of myocarditis by pox virus remain an area of study 7 . Monkeypox-associated viral pericarditis presented with a pericardial effusion which was mild, and it is suggested to have a suspicion in patients who show ECG changes of ST elevation associated with pain in the chest 6 . The published case reports are of patients who were unvaccinated for orthopoxvirus and were otherwise healthy without an immunocompromised state 6 , 7 .…”

“…Monkeypox-associated viral pericarditis presented with a pericardial effusion which was mild, and it is suggested to have a suspicion in patients who show ECG changes of ST elevation associated with pain in the chest 6 . The published case reports are of patients who were unvaccinated for orthopoxvirus and were otherwise healthy without an immunocompromised state 6 , 7 . Interestingly, myopericarditis also occurs as an adverse effect of smallpox vaccinations, as seen in the nationwide surveillance in the United States in 2003 8 .…”