Department of Internal Medicine, Social Insurance Gunma Chuo General Hospital, 1-7-13 Koun-cho, 371-0025 Maebashi, Gunma, Japan.
Virol J. 2014 Jan 13;11:3. doi: 10.1186/1743-422X-11-3.
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.
病毒性心肌炎可表现出多种症状，包括致命性心律失常和心源性休克，部分患者还可能发展为慢性心肌炎和扩张型心肌病。我们在此报告一例以肝功能障碍和胰腺炎为特征的病毒性心肌炎病例。一名 63 岁男性因呼吸困难而入院。初步检查显示肺部充血、完全性房室传导阻滞、左心室功能障碍、血清肌钙蛋白 I 升高和肝酶水平升高。入院后 5 天发生胰腺炎。进一步检查显示柯萨奇病毒 A4 抗体滴度升高。入院第 14 天，患者的左心室功能障碍、胰腺炎和肝功能障碍已得到缓解，但肌钙蛋白 I 水平仍较高，心肌活检显示心肌 T 淋巴细胞浸润，明确为急性心肌炎。入院 5 周后，因意外发现的晚期直肠癌行根治性低位前切除术。入院 6 个月后，患者的肌钙蛋白 I 和血浆脑钠肽水平恢复正常。目前已随访 2 年，左心室射血分数稳定。这是首例报道的成人柯萨奇病毒 A4 引起的心肌炎和胰腺炎。柯萨奇病毒感染引起的合并心肌炎和胰腺炎较为罕见。该患者的临床病程提示，与直肠癌相关的免疫反应改变可能有助于其病毒性心肌炎的改善。
