Article Type : Case Report
Authors : Gupta Dhruv, Dimitre Dimitrov and Nishi Yadav
Keywords : Monkeypox; Myocarditis
Monkeypox is a zoonotic Orthopoxvirus
infection primarily endemic to Central and Western Africa. In recent years,
there have been global outbreaks of monkeypox, including cases with atypical
cutaneous lesions. We present the case of a 25-year-old Nigerian male with
left-sided chest pain and vesiculopustular lesions predominantly in the
genital region. The patient was diagnosed with monkeypox infection complicated
by acute myocarditis, a rare presentation. Laboratory investigations, including
troponin T levels and cardiac imaging, supported the diagnosis. The patient
was treated with high-dose aspirin, blood thinners, antihypertensives, and NTG
for myocarditis, along with isolation to prevent transmission. The patient's
symptoms resolved with-in a week, and follow-up cardiac imaging showed no
sequelae of myocarditis.
Monkeypox, caused by a zoonotic Orthopoxvirus, is
typically a self-limited disease with mild symptoms. However, recent outbreaks
have shown cases with unusual cutaneous manifestations. Here, we describe a
rare case of monkeypox presenting with myocarditis, emphasizing the importance
of recognizing potential complications in infected patients.
A 25-year-old Nigerian male presented with left-sided
chest pain and vesiculopustular lesions involving the face, trunk, suprapubic
area, and extremities. The patient had associated fever, myalgia, and palpable
bilateral inguinal lymph nodes. Considering the clinical history and examination
findings, monkeypox infection was suspected.
Laboratory tests were unremarkable, except for
elevated troponin T levels. The 12-lead ECG showed persistent ST elevation in
anterior leads, and cardiac magnetic resonance imaging confirmed myocarditis.
Coronary angiography revealed normal lumen and blood flow in arteries, ruling
out coronary artery disease.
The patient received high-dose aspirin, blood
thinners, antihypertensives, and NTG for acute myocarditis. Additionally, he
was placed in isolation to prevent viral transmission. The patient remained
hemodynamically stable throughout his hospital stay, with resolution of chest
pain and normalization of troponin levels.
The patient's cutaneous lesions resolved within 21
days of isolation, and follow-up cardiac imaging after eight weeks showed no
signs of myocarditis or cardiac complications.
Myocarditis is a known complication of viral
infections, and viral myocarditis can be caused by direct viral injury or
immune-mediated mechanisms. There have been only a few reported cases of
monkey-pox-associated myocarditis. Our case adds to the limited literature on
this rare complication, suggesting that monkeypox may have tropism for the
myocardium or elicit an immune-mediated response [1-9].
This case highlights the potential complication of
myocarditis in patients with monkeypox infection. It emphasizes the importance
of monitoring patients for cardiac complications and considering
monkeypox-directed treatment in affected individuals. With wider availability
of tecovirimat, healthcare providers should be aware of the potential cardiac
implications and follow the guidelines provided by the Centers for Disease Control
and Prevention (CDC) for monkeypox treatment.
None disclosed.