Case report: From monkeypox pharyngitis to myopericarditis and atypical skin lesions
BackgroundA global outbreak of the human monkeypox virus (HMPXV), first identified in May 2022, was declared a health emergency of international concern on 23 July 2022. Before the global outbreak, monkeypox cases were mostly confined to central and west African countries, where this virus is preval...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1046498/full |
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| author | María Ascensión Sanromán Guerrero Elena Hernández Sánchez Belén de Nicolás Ruanes Pablo Fernández-González Sonia Antoñana Ugalde Alejandra González Leal Marcelo Sanmartín Fernández Jose Javier Alarcón Rodríguez Laura Martinez Garcia Rosa Escudero Maria Ángeles Fernández Méndez Jose Luis Zamorano Gómez Beatriz Montero Llorente Maria Jesús Vivancos-Gallego |
| author_facet | María Ascensión Sanromán Guerrero Elena Hernández Sánchez Belén de Nicolás Ruanes Pablo Fernández-González Sonia Antoñana Ugalde Alejandra González Leal Marcelo Sanmartín Fernández Jose Javier Alarcón Rodríguez Laura Martinez Garcia Rosa Escudero Maria Ángeles Fernández Méndez Jose Luis Zamorano Gómez Beatriz Montero Llorente Maria Jesús Vivancos-Gallego |
| author_sort | María Ascensión Sanromán Guerrero |
| collection | DOAJ |
| description | BackgroundA global outbreak of the human monkeypox virus (HMPXV), first identified in May 2022, was declared a health emergency of international concern on 23 July 2022. Before the global outbreak, monkeypox cases were mostly confined to central and west African countries, where this virus is prevalent. Close contact, mainly sexual contact, is supposed to be the main route of transmission, and it is remarkable that the incidence is higher in men who have sexual relationships with other men.Case summaryA 40-year-old Caucasian man arrived at the emergency department complaining of oppressive epigastric pain extending to the chest after a diagnosis of pharyngitis, which was suspected to be caused by the human monkeypox virus. Based on the clinical symptoms, physical examination, serum cardiac biomarkers, and electrocardiographic findings, he was diagnosed with myopericarditis. The real-time PCR for human monkeypox in skin lesions, urine, plasma, and the oropharyngeal swab was positive. The peak of troponin I was 20.6 ng/ml, and the electrocardiogram showed an upward concavity in the ST segment in diffuse leads, which was in agreement with the previous diagnosis. The presence of edema, subepicardial, and myocardial late gadolinium enhancement, and increased values on T1 mapping in the cardiac MRI were in agreement with the diagnosis of myopericarditis. Antiviral treatment with tecovirimat was started with excellent tolerability. After 6 days, the patient recovered and was discharged.DiscussionTo our knowledge, this is one of the first reported cases of myopericarditis due to human monkeypox infection, which was confirmed by a cardiac MRI following modified Lake Louise criteria. The short span between the onset of the mucocutaneous symptoms and the myocardial damage suggests a pathogenic association. Furthermore, the active viral replication in plasma samples and the negative results on real-time PCR for other viruses support this clinical association. |
| first_indexed | 2024-04-11T00:44:18Z |
| format | Article |
| id | doaj.art-1568db25579742f3b30e6f5ffa73961b |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T00:44:18Z |
| publishDate | 2023-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-1568db25579742f3b30e6f5ffa73961b2023-01-05T19:56:23ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-01-01910.3389/fcvm.2022.10464981046498Case report: From monkeypox pharyngitis to myopericarditis and atypical skin lesionsMaría Ascensión Sanromán Guerrero0Elena Hernández Sánchez1Belén de Nicolás Ruanes2Pablo Fernández-González3Sonia Antoñana Ugalde4Alejandra González Leal5Marcelo Sanmartín Fernández6Jose Javier Alarcón Rodríguez7Laura Martinez Garcia8Rosa Escudero9Maria Ángeles Fernández Méndez10Jose Luis Zamorano Gómez11Beatriz Montero Llorente12Maria Jesús Vivancos-Gallego13Department of Cardiology Medicine, Hospital Ramón y Cajal, Madrid, SpainDepartment of Cardiology Medicine, Hospital Ramón y Cajal, Madrid, SpainDepartment of Dermatology, Hospital Ramón y Cajal, Madrid, SpainDepartment of Dermatology, Hospital Ramón y Cajal, Madrid, SpainDepartment of Cardiology Medicine, Hospital Ramón y Cajal, Madrid, SpainDepartment of Cardiology Medicine, Hospital Ramón y Cajal, Madrid, SpainDepartment of Cardiology Medicine, Hospital Ramón y Cajal, Madrid, SpainDepartment of Radiology, University Hospital Ramón y Cajal, Madrid, SpainDepartment of Microbiology, University Hospital Ramón y Cajal and IRYCIS, Universidad de Alcalá, CIBERESP, Madrid, SpainDepartment of Infectious Diseases, University Hospital Ramón y Cajal and IRYCIS, Universidad de Alcalá, CIBERINFEC, Madrid, SpainDepartment of Radiology, University Hospital Ramón y Cajal, Madrid, SpainDepartment of Cardiology Medicine, Hospital Ramón y Cajal, Madrid, SpainDepartment of Clinical Pharmacology, Hospital Ramón y Cajal, Madrid, SpainDepartment of Infectious Diseases, University Hospital Ramón y Cajal and IRYCIS, Universidad de Alcalá, CIBERINFEC, Madrid, SpainBackgroundA global outbreak of the human monkeypox virus (HMPXV), first identified in May 2022, was declared a health emergency of international concern on 23 July 2022. Before the global outbreak, monkeypox cases were mostly confined to central and west African countries, where this virus is prevalent. Close contact, mainly sexual contact, is supposed to be the main route of transmission, and it is remarkable that the incidence is higher in men who have sexual relationships with other men.Case summaryA 40-year-old Caucasian man arrived at the emergency department complaining of oppressive epigastric pain extending to the chest after a diagnosis of pharyngitis, which was suspected to be caused by the human monkeypox virus. Based on the clinical symptoms, physical examination, serum cardiac biomarkers, and electrocardiographic findings, he was diagnosed with myopericarditis. The real-time PCR for human monkeypox in skin lesions, urine, plasma, and the oropharyngeal swab was positive. The peak of troponin I was 20.6 ng/ml, and the electrocardiogram showed an upward concavity in the ST segment in diffuse leads, which was in agreement with the previous diagnosis. The presence of edema, subepicardial, and myocardial late gadolinium enhancement, and increased values on T1 mapping in the cardiac MRI were in agreement with the diagnosis of myopericarditis. Antiviral treatment with tecovirimat was started with excellent tolerability. After 6 days, the patient recovered and was discharged.DiscussionTo our knowledge, this is one of the first reported cases of myopericarditis due to human monkeypox infection, which was confirmed by a cardiac MRI following modified Lake Louise criteria. The short span between the onset of the mucocutaneous symptoms and the myocardial damage suggests a pathogenic association. Furthermore, the active viral replication in plasma samples and the negative results on real-time PCR for other viruses support this clinical association.https://www.frontiersin.org/articles/10.3389/fcvm.2022.1046498/fullmyocarditispericarditistecovirimatmonkeypoxLake Louise criteriaplasma |
| spellingShingle | María Ascensión Sanromán Guerrero Elena Hernández Sánchez Belén de Nicolás Ruanes Pablo Fernández-González Sonia Antoñana Ugalde Alejandra González Leal Marcelo Sanmartín Fernández Jose Javier Alarcón Rodríguez Laura Martinez Garcia Rosa Escudero Maria Ángeles Fernández Méndez Jose Luis Zamorano Gómez Beatriz Montero Llorente Maria Jesús Vivancos-Gallego Case report: From monkeypox pharyngitis to myopericarditis and atypical skin lesions Frontiers in Cardiovascular Medicine myocarditis pericarditis tecovirimat monkeypox Lake Louise criteria plasma |
| title | Case report: From monkeypox pharyngitis to myopericarditis and atypical skin lesions |
| title_full | Case report: From monkeypox pharyngitis to myopericarditis and atypical skin lesions |
| title_fullStr | Case report: From monkeypox pharyngitis to myopericarditis and atypical skin lesions |
| title_full_unstemmed | Case report: From monkeypox pharyngitis to myopericarditis and atypical skin lesions |
| title_short | Case report: From monkeypox pharyngitis to myopericarditis and atypical skin lesions |
| title_sort | case report from monkeypox pharyngitis to myopericarditis and atypical skin lesions |
| topic | myocarditis pericarditis tecovirimat monkeypox Lake Louise criteria plasma |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1046498/full |
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