Convulsiones y paro cardiaco: forma inhabitual de presentación de miocarditis asociada a virus de Epstein Barr

Abstract

Epstein Barr virus myocarditisThe incidence of cardilis in infectious mononucleosis is low. Clinical manifestations of heart involvement Include electrocardiographic changes in 6% and caidiac symptoms in 0.7% of confirmed cases. A previously healthy 9 year old boy came to the emergency room of a melropolitan children's hospilal at Sanliago, Chile, because of generalized Ionic seizures, which did nol respond to phenoborbital and neither to diazepam. He was transferred to the intensive care unit in coma, score 3 by Glasgow Scale, with irregular bradicardia and recurrent apnea. He was conecled lo mechanical ventilation. His cardiac monitoring, showed complete atrioventricular Hock with atrial rate 1 50 : min and ventricular rate 53: min. He had five episodes of asystole, requiring cardiorespiratory resuscitation, isoproterenol, dopamine and prednisone. His course was critical with hypotension, persisting AV block and, 24 hours after admission had a new period of asystole: an external pacemaker was then installed. Chest x ray showed heart enlargement. Echocardiographic findings included right atrial and ventricular dilation, wall edema and lowered left ventricular performance. Serum creatine phosphokinase activity was 196 U/l at admitance and 29 U/l six days later, while serum levels of muscle brain isoenzime were 53 U/l and 22 U/l respectively, thus suggesting myocardial injury. Serological investigations for echo and coxsackie viruses were negative. Epstein Barr virus anticapside IqM on arrival and at day ten after admission was 1/40 [highest dilution title], C-reactive protein 6 mg/l, erilhrocite sedimentation rate 10 mm/h., search for rheumatoid factor gave negative results. Isoprotsrenol was continued for three days, dopamine for nine days and external pacemaker for 1 7 days. He was dismissed at t 8 days after admission wilhoul pharmacological or electrical support, in sinus rhythm with isolated ventricular extrasystoles.(Key words t Myocarditis, Epstein Barr virus, complete heart block.)