acyclovir and Pericarditis

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

We describe the case of a 19-year-old male diagnosed with Reye syndrome within the context of viral pericarditis and salicylate ingestion. He presented a fatal brain oedema without liver failure. Brain biopsies obtained during a decompressive craniectomy led to the diagnosis.

Topics: Acyclovir; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Aspirin; Brain Edema; Coma; Decompressive Craniectomy; Fatal Outcome; Glasgow Coma Scale; Humans; Magnetic Resonance Imaging; Male; Pericarditis; Resuscitation; Reye Syndrome; Seizures; Virus Diseases; Young Adult

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

While evidence-based medicine may be trumpeted by zealots, managers and politicians, incorporating it into clinical practice is easier said than done. The present article aims to show that it can be achieved and gives some clinical examples to illustrate this. An appendix contains a summary of useful databases and websites for accessing good medical information and evidence, quickly and reliably near the bedside.

Topics: Acyclovir; Adult; Chest Pain; Colchicine; Diagnosis, Differential; Emergency Medicine; Evidence-Based Medicine; Female; Ginkgo biloba; Gout Suppressants; Herpes Zoster; Humans; Male; Migraine Disorders; Myocardial Infarction; Pericarditis; Phytotherapy; Plant Preparations; Troponin