Abstract
Viral myocarditis presents with various symptoms, including fatal arrhythmia and cardiogenic shock, and may develop chronic myocarditis and dilated cardiomyopathy in some patients. We report here a case of viral myocarditis with liver dysfunction and pancreatitis. A 63-year-old man was admitted to our hospital with dyspnea. The initial investigation showed pulmonary congestion, complete atrioventricular block, left ventricular dysfunction, elevated serum troponin I, and elevated liver enzyme levels. He developed pancreatitis five days after admission. Further investigation revealed a high antibody titer against coxsackievirus A4. The patient’s left ventricular dysfunction, pancreatitis, and liver dysfunction had resolved by day 14, but his troponin I levels remained high, and an endomyocardial biopsy showed T-lymphocyte infiltration of the myocardium, confirming acute myocarditis. The patient underwent radical low anterior resection five weeks after admission for advanced rectal cancer found incidentally. His serum troponin I and plasma brain natriuretic peptide levels normalized six months after admission. He has now been followed-up for two years, and his left ventricular ejection fraction is stable.This is the first report of an adult with myocarditis and pancreatitis attributed to coxsackievirus A4. Combined myocarditis and pancreatitis arising from coxsackievirus infection is rare. This patient’s clinical course suggests that changes in his immune response associated with his rectal cancer contributed to the amelioration of his viral myocarditis.
Highlights
Myocarditis can present with a wide range of symptoms, ranging from mild dyspnea to chest pain, cardiogenic shock, and fatal arrhythmia
We present here a rare case of CVA4 infection causing acute myocarditis with concomitant pancreatitis and liver dysfunction
These results suggest that the rate of latent or asymptomatic pancreatitis may be higher than previously thought in patients with myocarditis attributable to CV infection
Summary
Myocarditis can present with a wide range of symptoms, ranging from mild dyspnea to chest pain, cardiogenic shock, and fatal arrhythmia. The patient’s antibody titers against CVA4 were significantly elevated during the recovery period, and a pathological examination of an EMB specimen showed interstitial infiltration with CD3-positive lymphocytes, despite a normal LVEF on left ventriculography, confirming acute myocarditis. His plasma brain natriuretic peptide (BNP) and serum troponin I (TnI) levels remained elevated. A histological examination of the surgical specimen showed lymphovascular invasion, and adjuvant chemotherapy with folinic acid, fluorouracil, and oxaliplatin was commenced a month after discharge His plasma BNP level decreased to less than half the preoperative value (78 pg/mL) and his serum TnI level returned to normal (< 0.04 ng/mL) three weeks after surgery. The patient has been followed-up for two years, with stable LVEF and no recurrence of myocarditis or rectal cancer
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
