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

• Published in: BMC research notes 2016-08, Vol.9 (1), p.391-391, Article 391
• Main Authors: Magno Palmeira, Moacyr, Umemura Ribeiro, Hellen Yuki, Garcia Lira, Yan, Machado Jucá Neto, Fernando Octávio, da Silva Rodrigues, Ivone Aline, Fernandes da Paz, Letícia Nazareth, Nascimento Pinheiro, Maria da Conceição
• Format: Article
• Language: English
• Subjects: Adult; Case Report; Complications and side effects; Cytomegalovirus - physiology; Cytomegalovirus infections; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - diagnostic imaging; Cytomegalovirus Infections - drug therapy; Development and progression; Electrocardiography; Ganciclovir - therapeutic use; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - drug therapy; Heart Failure - etiology; Humans; Immunocompetence; Liver - enzymology; Male; Myocarditis - complications; Myocarditis - diagnostic imaging; Myocarditis - drug therapy; Myocarditis - virology; Radiography, Thoracic; Risk factors; Young Adult
• ISSN: 1756-0500; 1756-0500
• DOI: 10.1186/s13104-016-2181-5

Cardiac 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. A 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. This case reaffirms the possibility of cardiac involvement in CMV infection and emphasises the importance of viral aetiologies as differential diagnoses for acute myocarditis.