Myocarditis mimicking acute coronary syndrome following influenza B virus infection: a case report

Abstract

We present a notable case of a 15-year-old male infected with influenza B virus who showed the clinical manifestations of myocardial ischemia. He was admitted to our hospital with sudden chest pain. He had febrile illness for the past 2 days. Rapid antigen test for influenza revealed positive influenza B virus antigen. The initial electrocardiogram showed elevation of the ST-segments in leads II, II, aVF and reciprocal depression in leads V1 and V2. Serum test showed elevation of creatine kinase and troponin T. Gadlinium-enchanced magnetic resonance imaging, Tl-201 and I-123 beta-methyl-p-iodephenyl-pentadecanoic acid scintigram, coronary angiography revealed no abnormality. Follow-up electrocardiogram showed ST-segment change improvement over the course. Myocarditis associated with influenza B virus seemed to be caused by endothelial impairment and disturbance of microcirculation rather than direct injury to cardiac myocytes.

Neuraminidase inhibitors for influenza B virus infection: Efficacy and resistance

“…Other extrapulmonary complications include central nervous system involvement, such as viral encephalitis and encephalopathy, gastrointestinal symptoms, or myositis (Craver et al, 1997; Frank et al, 2010; Muneuchi et al, 2009; Newland et al, 2003; Tabbutt et al, 2004; Wright, 2006). Additional studies designed specifically for populations with influenza B virus infections are needed to properly estimate the burden of complications.…”

Fulminant fatal swine influenza (H1N1): Myocarditis, myocardial infarction, or severe influenza pneumonia?

“…A combination of direct cytolytic effects of the influenza virus/host immune response is thought to be responsible for the overall pathologic changes in acute influenzal myocarditis. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Of the many causes of viral myocarditis, influenza A and B are not the most common causes but are important. The clinical presentation of myocarditis is often subtle, and the only sign is often unexplained tachycardia.…”

“…Myocardial biopsies reveal inflammatory infiltrates with or without necrosis. [10][11][12][13][14][15][16][17][18][19][20] Myocarditis is a recognized complication of viral influenza. 7,[10][11][12][13][14][15]18 Viral myocarditis due to influenza runs the clinical spectrum from asymptomatic disease with only electrocardiographic or echocardiographic abnormalities to fulminant/fatal myocarditis.…”

“…H1N1 pneumonia may be accompanied by a variety of extrapulmonary findings (Table I). [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In our experience, H1N1 rarely has been complicated by encephalitis. Only during the "fall wave" of the H1N1 pandemic did we encounter adults with cardiac complications.…”

A National Survey on Myocarditis Associated With the 2009 Influenza A (H1N1) Pandemic in Japan

“…21 Muneuchi et al reported that myocarditis associated with influenza B virus appeared to be caused by endothelial impairment and disturbance of microcirculation rather than direct injury to cardiac myocytes. 22 These findings suggest that a negative quick diagnostic test of patients with systemic symptoms might lead to hospitalization due to symptomatic viral pneumonia, or myocarditis, and the pathogenesis of systemic complications of influenza might be related to the induction of inflammatory cytokines produced by infected alveolar cells.…”