acyclovir and Myocarditis

A case of varicella myocarditis in a previously healthy 6-year-old child was reviewed. The patient presented with third-degree heart block and shock as the sole manifestation of her cardiac involvement. Bradyarrhythmias required temporary transvenous pacing. Intravenous acyclovir was used. The patient recovered without permanent sequelae. The natural history, clinical presentation, and treatment of varicella myocarditis are reviewed.

Topics: Acyclovir; Bradycardia; Cardiac Pacing, Artificial; Chickenpox; Child; Electrocardiography; Female; Heart Block; Humans; Infusions, Intravenous; Isoproterenol; Myocarditis; Shock, Cardiogenic

Herpes simplex virus (HSV) rarely causes organ-invasive infection. Diagnosis and treatment for such infections are often delayed, and mortality is high. We present the first reported case of disseminated HSV-1 infection in an adult causing liver failure, myocarditis, and encephalitis in a patient who recovered after receiving parenteral acyclovir treatment.. A 46-year-old female presented with fever, chills, and malaise after 2 weeks of oral corticosteroid treatment for uveitis. She was diagnosed with disseminated HSV-1 infection with multi-organ involvement causing hepatitis, encephalitis, and myocarditis. Diagnosis was made timely using serum polymerase chain reaction (PCR) for HSV DNA and the patient was given intravenous acyclovir treatment promptly, which led to her survival without significant morbidity.. Clinicians should have a low threshold for suspecting HSV infection and ordering HSV PCR to decrease morbidity and mortality when there is a high clinical suspicion of systemic HSV infection with multi-organ involvement. Serum PCR for HSV DNA is an excellent modality for an initial diagnostic approach. Further research is warranted to elucidate causality between a course of corticosteroid therapy and systemic HSV-1 infection without major immunosuppressive comorbidities or treatments.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Encephalitis; Encephalitis, Herpes Simplex; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Middle Aged; Myocarditis

The varicella zoster virus (VZV) belongs to cardiotropic viruses, although the frequency of cardiac complications during VZV infection is low. Diagnosis of myocarditis or myopericarditis is rare during varicella - primary infection of VZV and sporadic in zoster - reactivation of latent VZV. Only few such cases have been described. The authors present a case of a 23-year-old male in whom clinical symptoms of myopericarditis developed a week after diagnosis of zoster that was localized in the left-upper part of the thorax. Retrosternal chest pain and fever were accompanied by ECG mimicking acute myocardial infarction. A dynamic pattern of troponin I release and slow normalization of ECG were observed. Serial echocardiography showed normal left ventricular function, transient changes in echogenicity of the interventricular septum and small pericardial effusion. In magnetic resonance imaging subepicardial and intramyocardial areas of late gadolinium enhancement were found. He was treated with intravenous acyclovir. No late sequels of the disease were observed.

Topics: Acyclovir; Chest Pain; Echocardiography; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Myocarditis; Pericarditis; Young Adult

Topics: Acyclovir; Adolescent; Anti-Arrhythmia Agents; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Atenolol; Chest Pain; Chickenpox; Diagnosis, Differential; Diclofenac; Female; Heart; Humans; Magnetic Resonance Imaging; Myocarditis; Myocardium

A 34-year-old dental nurse presented with a 2-day history of retrosternal chest pain that was constant and 'burning' in nature. She was otherwise fit and well, no significant prior medical history and no ischaemic heart disease risk factors. Clinical examination was entirely normal apart from pyrexia of 38.3°C. Admission ECG showed ST depression in the inferior and anterolateral leads suggestive of myocardial ischaemia, consequently a CT coronary angiogram (CTCA) was performed. This showed normal coronary arteries, incidental distal oesophageal thickening was seen. Further history taking revealed that her youngest daughter had recently suffered from cold sores. The patient went on to have a diagnostic procedure, an oesophagogastroduodenoscopy. Biopsies confirmed acute oesophagitis with features suggestive of herpes virus infection. The patient responded promptly to oral acyclovir. This case highlights the value of CT coronary angiogram in identifying non-cardiac pathology in patients with a low pretest probability of coronary artery disease.

Topics: Acute Coronary Syndrome; Acyclovir; Adult; Antiviral Agents; Chest Pain; Coronary Angiography; Diagnosis, Differential; Esophagitis; Female; Herpesviridae Infections; Humans; Myocarditis; Pericarditis; Tomography, X-Ray Computed

Inflammatory dilated cardiomyopathy (DCMi) represents an acquired form of dilated cardiomyopathy. Viral infection is the most common cause of DCMi. In contrast with other cardiotropic viruses, herpes simplex virus (HSV) is a very rare finding in endomyocardial biopsies of patients with dilated cardiomyopathy. We report a case of HSV-induced cardiomyopathy successfully treated with acyclovir.

Topics: Acyclovir; Antiviral Agents; Cardiomyopathy, Dilated; Herpes Simplex; Humans; Male; Middle Aged; Myocarditis; Treatment Outcome

This study reports the development of lymphocytic myocarditis in a bilateral lung allograft recipient. A 23-year-old woman developed congestive heart failure and severe left ventricular dysfunction 32 months after a bilateral lung allograft for cystic fibrosis. She had taken oral acyclovir for infectious mononucleosis that was diagnosed 11 months previously. Her viral load for Epstein-Barr virus (EBV) increased, and an echocardiogram revealed a left ventricular ejection fraction of 25% and endomyocardial biopsy revealed lymphocytic myocarditis. She received valacyclovir (1 g x 3 times daily) and made a full recovery 6 months later.

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy, Needle; Cystic Fibrosis; Female; Follow-Up Studies; Heart Failure; Humans; Immunohistochemistry; Infectious Mononucleosis; Lung Transplantation; Lymphocytes; Myocarditis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infectious Mononucleosis; Myocarditis; Prednisolone

Primary varicella-zoster virus (VZV) infections in adults generally follow a more severe course than in children and are more often associated with life-threatening complications. In the years 1992 to 1995 we observed 7 immunocompetent adults with a severe course of primary VZV infection. All 7 patients presented initially with a characteristic rash. In 6 patients the diagnosis of VZV was confirmed by ELISA on material taken from the lesions, and in all of them it was confirmed by serology. The following complications were observed: pneumonia (5x), elevated liver enzymes (4x), myocarditis (1x), encephalitis (1x) and myelitis (1x). Pulmonary lesions were characterized by bilateral interstitial infiltrates on chest-x-ray and required mechanical ventilation in 2 patients. The liver enzymes were only slightly elevated and clinically not significant. Myocarditis in one case was postulated in view of elevated creatine kinase levels, ECG-repolarization changes and AV-block III which required the insertion of a transitory pacemaker. Encephalitis presented as abnormal behaviour at work followed by seizures. Myelitis was suspected due to ascending sensory motor tetraparesis and confirmed by MRI. All patients were treated with high doses of parenteral acyclovir (3 x 10 mg/kg body weight i.v. per day) for 5-12 days. 6 patients recovered completely and only the patient with myelitis has residual neurological deficits 3 months after discharge. Although we cannot exclude the possibility that supportive therapy without acyclovir would have had the same outcome, we recommend high-dose parenteral acyclovir for treatment of visceral and neurological complications in primary VZV infections in adults.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Encephalitis, Viral; Female; Herpesvirus 3, Human; Humans; Male; Middle Aged; Myelitis; Myocarditis; Pneumonia, Viral

Topics: Acyclovir; Adult; Herpes Zoster; Humans; Male; Myocarditis

Topics: Acyclovir; Adult; Cytomegalovirus Infections; Ganciclovir; Heart Transplantation; Humans; Male; Myocarditis; Opportunistic Infections

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Kidney Transplantation; Male; Middle Aged; Myocarditis; Pneumonia, Viral; Postoperative Complications