Myocardial calcification found in Epstein–Barr viral myocarditis and rhabdomyolysis

Abstract

Rationale:The Epstein–Barr (EB) virus has rarely been reported as a cause of fulminant myocarditis. To our knowledge, the present case is the first report on myocardial calcification in EB viral myocarditis and rhabdomyolysis.Patient concerns:A 17-year-old man was admitted to the department with fever, chest tightness, and tachypnea that had been present for 2 days.Diagnoses:The initial investigation showed elevated liver enzyme levels, creatine kinase levels, creatine kinase isoenzyme levels, and elevated serum myoglobin. Echocardiography showed that left ventricular motion amplitude decreased. Test for immunoglobin M and immunoglobin G antibodies against Epstein–Barr virus were positive. These findings were consistent with fulminant myocarditis, cardiogenic shock, and rhabdomyolysis.Interventions:The patient was intensively treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO), continuous renal replacement therapy (CRRT).Outcomes:Myocardial calcification was observed in the left ventricle walls on CT examination 10 days after the admission. Four months later, the patient is still alive and with adequate daily life.Lessons:This case indicates that this rare form of myocardial calcification may be associated with EB viral infection and rhabdomyolysis.

Epstein–Barr virus infection leading to multiorgan involvement in an immunocompetent man

“…Sui et al reported a 17‐year‐old male with fulminant EBV myocarditis and rhabdomyolysis who developed extensive calcification of left ventricular walls. Despite the severe progression of the disease, he survived eventually with favorable follow‐up evaluations 21 . Watanabe et al described acute EBV myocarditis in a young female, complicated with malignant ventricular arrhythmias and cardiac arrest.…”

Cardiovascular involvement in Epstein–Barr virus infection

“…Heart failure is a symptom and sign of cardiac dysfunction. Undoubtedly, all EBV-related organic diseases of the heart, including myocarditis, CAI, pericardial effusion, and cardiac valvulopathies, could lead to heart failure ( 14 , 17 , 31 , 32 ).…”

“…In terms of sex, there were 28 male ( 7 , 12 , 16 , 18 , 20 , 23 , 25 , 27 , 28 , 30 – 34 ) and 26 female patients ( 6 , 8 , 9 , 13 , 15 , 17 , 19 , 21 , 22 , 24 , 26 – 29 , 31 , 35 ). Regarding the diagnosis of EBV infection, 23 (42.6%) were diagnosed with AEBV ( 6 , 13 – 15 , 17 , 18 , 25 , 27 , 32 ), 20 (37.0%) with CAEBV ( 7 , 8 , 16 , 19 – 22 , 28 – 31 , 34 ), 6 (11.1%) had a complication of CAEBV and HLH ( 12 , 24 , 28 , 31 ), 4 (7.4%) had a diagnosis of EBV-HLH ( 9 , 23 , 33 , 35 ), and 1 (1.9%) had reactivated EBV ( 26 ).…”

“…There were seven articles reporting EBV-associated myocarditis ( 6 , 9 , 14 , 17 , 18 , 20 , 32 ), of which two were American ( 14 , 18 ), two were Italian ( 6 , 17 ), one was Chinese ( 32 ), and two were Japanese ( 9 , 20 ), with a total of seven patients, consisting of one (14.3%) child ( 9 ) and six (85.7%) adults ( 6 , 14 , 17 , 18 , 20 , 32 ). There were four (57.1%) male ( 14 , 18 , 20 , 32 ) and three (42.9%) female patients ( 6 , 9 , 17 ). The average age of the adults was 32.5 years (range, 19.25–64 years).…”

“…The average age of the adults was 32.5 years (range, 19.25–64 years). Regarding the diagnosis of EBV, five (71.4%) had a diagnosis of AEBV ( 6 , 14 , 17 , 18 , 32 ), one (14.3%) had a diagnosis of CAEBV ( 20 ), and one (14.3%) had a diagnosis of EBV-HLH ( 9 ).…”