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      Varicella-Zoster Myocarditis Mimicking Acute Myocardial Infarction

      case-report

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          Abstract

          A 23-year-old male was admitted with chest pain. The electrocardiogram showed ST elevation in leads DI, aVL, V2-V6. Troponin T was 1.1ng/mL. Left ventricular systolic function was globally reduced (ejection fraction 45%). The patient was treated with thrombolytic. Twenty-four hours after admission pruriginous vesicles with a clear content and surrounded by a pink halo appeared on his face, head and torso, suggesting varicella-zoster infection. This case illustrates the difficulties of diagnosis in acute myocarditis.

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          Cardiac complications in children following infection with varicella zoster virus.

          G Derrick, Will D. Penny, D Abrams … (2001)
          Infection with varicella zoster virus, leading to chicken pox in susceptible hosts, is usually a benign self-limiting disease conferring immunity in those affected. Cardiac complications are rare, but when present may lead to severe morbidity or mortality. We have recently encountered three children, all of whom developed significant cardiac complications secondary to infection with varicella. Myocarditis has long been associated with such infection. The pathological mechanism is presumed similar to other cardiotropic viruses, where both direct cytopathic and secondary auto-immune effects contribute to myocardial cellular destruction and ventricular dysfunction. Complications include arrhythmias and progression to dilated cardiomyopathy. Pericarditis, and secondary pericardial effusion, related to infection with the virus is most commonly associated with secondary bacterial infiltration. Both cardiac tamponade and chronic pericardial constriction may result. Endocarditis complicating varicella has only been described in the last fifteen years, and is associated with the emergence of virulent strains of both streptococcus and staphylococcus, the two organisms most commonly associated with endocarditis. The exact mechanism by which varicella causes secondary bacterial endocarditis remains unclear. Whilst cardiac complications of infection with the varicella zoster virus are rare, the resulting complications are potentially life threatening. Evidence of varicella-induced carditis must be aggressively pursued in any child with signs of acute cardiac decompensation in whom chicken pox is confirmed or suspected.
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            [Evaluation of varicella complications through a retrospective hospital survey in a paediatric center over 16 years in France].

            E. MALLET, M Maitre, L Delalande-Dutilleul … (2004)
            Evaluation of the varicella severity through a prevalence study of hospital admissions justified by a complication directly related to the onset of an acute episode of varicella. Retrospective study in one paediatric center in France with a follow-up of a paediatric cohort from April 1987 to December 2002. This general paediatric hospital recruits children from a 400,000 inhabitants area. Inclusion criterion: diagnosis main or associated of varicella. congenital or acquired immunodepression, including long-term oral high dosage steroid therapy. Three hundred and forty-three (343) complications of varicella were reported in 309 children hospitalised for a symptom in relationship with varicella. Most of children (75%) were <2 years of age. The annual number of hospitalisations varied with a maximum of 44. An increase of the number of hospitalisations was reported since 1997 but particularly since 2000. Main complications were gastro-intestinal (75), neurological (68), bronchopulmonary (52), and skin and soft tissue infections (52). Superinfections of soft tissues such as Streptococcus pyogenes cellulitis and life-threatening complications, which occurred in children treated by a short-course of corticosteroïds for an acute episode such as an asthma crisis, were mostly noticed since 1995. Two deaths occurred. These data collected over 16 years as part of a retrospective survey of a paediatric cohort show that varicella, often considered as a mild disease, can be responsible for severe complications in young immunocompetent children. The digestive complications (30%) are the main complication in our study with existence of gingivitis-stomatitis but also lower digestive manifestations (erosive gastritis aspect through endoscopy). These data have all the more to be taken into account because a vaccine, developed for healthy children, is now available in France. A national survey of hospitalised varicella has been set up since March 2003.
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              Varicella myopericarditis mimicking myocardial infarction in a 17-year-old boy.

              Aliva De, Dorothy Myridakis, Margot Kerrigan … (2011)
              Varicella (chickenpox), a common childhood infection caused by the varicella-zoster virus, is self-limiting and usually benign. Although atypical manifestations of the virus are occasionally seen, it rarely presents with cardiovascular sequelae. Cardiovascular complications of varicella can include pericarditis, myocarditis, or endocarditis. Herein, we report the case of a 17-year-old boy who had varicella infection and severe chest pain. Examination revealed atypical electrocardiographic findings of pericarditis and remarkably elevated cardiac biomarker levels: peak cardiac troponin I, 37.2 ng/mL; total creatine kinase, 1,209 U/L; and creatine kinase-MB fraction, 133.6 ng/mL. After results of coronary angiography reliably excluded ischemia and myocardial infarction, the diagnosis was varicella myopericarditis. The patient was placed on a medical regimen during and after 5 days of hospitalization. In 2 weeks, he was asymptomatic, and at 6 months, he was doing well and had normal electrocardiographic and echocardiographic results.To our knowledge, cardiac enzyme elevations to these levels have not been reported in cases of cardiovascular sequelae of varicella. We discuss the diagnostic challenges of this atypical case and suggest that clinicians be aware that varicella disease is most often, but not always, benign.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Curr Health Sci J
                Journal ID (iso-abbrev): Curr Health Sci J
                Journal ID (publisher-id): CHSJ
                Title: Current Health Sciences Journal
                Publisher: Medical University Publishing House Craiova
                ISSN (Print): 2067-0656
                ISSN (Electronic): 2069-4032
                Publication date (Print): Jan-Mar 2014
                Publication date (Electronic): 29 December 2013
                Volume: 40
                Issue: 1
                Pages: 78-80
                Affiliations
                [1 ]Department of Morphology, Faculty of Dentistry, UMF Craiova
                Author notes
                Corresponding Author: I. Donoiu Department of CardiologyUniversity of Medicine and Pharmacy of Craiova, Craiova Cardiology Center 1st Tabaci StreetCraiova 200640Romania i.donoiu@ 123456gmail.com
                Article
                Publisher ID: 2014.1.16
                DOI: 10.12865/CHSJ.40.01.16
                PMC ID: 4006337
                PubMed ID: 24791213
                SO-VID: baba2d78-3679-4285-aa02-0863ae33136e
                Copyright © Copyright © 2014, Medical University Publishing House Craiova
                License:

                This is an open-access article distributed under the terms of a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Public License, which permits unrestricted use, adaptation, distribution and reproduction in any medium, non-commercially, provided the new creations are licensed under identical terms as the original work and the original work is properly cited.

                History
                Date received : 28 October 2013
                Date accepted : 15 November 2013
                Categories
                Subject: Case Reports

                Keywords: varicella-zoster,myocardial infarction,myocarditis
                Data availability:
                Keywords: varicella-zoster, myocardial infarction, myocarditis

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