Magno Palmeira Moacyr, Umemura Ribeiro Hellen Yuki, Garcia Lira Yan, Machado Jucá Neto Fernando Octávio, da Silva Rodrigues Ivone Aline, Fernandes da Paz Letícia Nazareth, Nascimento Pinheiro Maria da Conceição
Section of Urgency and Emergency, Division of Cardiology, Department of Intensive Care, Fundação Pública Estadual Hospital de Clínicas Gaspar Vianna, 2000 Alferes Costa street, Pedreira, 66087-660, Belém, PA, Brazil.
Section of Urgency and Emergency, Division of Cardiology, Department of Clinical Care, Universidade do Estado do Pará, 2623 Perebebuí street, Marco, 66087-670, Belém, PA, Brazil.
BMC Res Notes. 2016 Aug 5;9:391. doi: 10.1186/s13104-016-2181-5.
Cardiac complications constitute a rare clinical manifestation of cytomegalovirus (CMV) infection. This virus is usually asymptomatic in immunocompetent individuals. We report a case of myocarditis and cardiac insufficiency due to primary CMV infection. Serological tests by using ELISA method showed positive results for the virus.
A 41-year-old man with no prior comorbidities presenting with dyspnoea, fever, and oedema was admitted to the cardiac emergency service. He had fever and dry cough, which aggravated into progressive respiratory distress, lower limb oedema, and orthopnoea 30 days prior to hospitalisation. The electrocardiogram revealed sinus tachycardia, first-degree right bundle branch block, and ventricular and left atrial overload as well as diffuse and nonspecific disturbances of ventricular repolarization. Serological tests were conducted, and IgM (1.54 UI/mL) and IgG (2.5 UI/mL) were found positive only for CMV by using ELISA. The patient was diagnosed with cardiac insufficiency due to CMV myocarditis. He was treated with ganciclovir for 10 days and received supportive medication.
This case reaffirms the possibility of cardiac involvement in CMV infection and emphasises the importance of viral aetiologies as differential diagnoses for acute myocarditis.
心脏并发症是巨细胞病毒（CMV）感染的一种罕见临床表现。该病毒在免疫功能正常的个体中通常无症状。我们报告一例原发性CMV感染导致的心肌炎和心脏功能不全病例。采用酶联免疫吸附测定（ELISA）法进行的血清学检测显示该病毒呈阳性结果。
一名无既往合并症的41岁男性，因呼吸困难、发热和水肿入住心脏急救科。他在入院前30天出现发热和干咳，随后逐渐加重为进行性呼吸窘迫、下肢水肿和端坐呼吸。心电图显示窦性心动过速、一度右束支传导阻滞、心室及左心房负荷过重以及弥漫性和非特异性心室复极异常。进行了血清学检测，采用ELISA法仅发现巨细胞病毒的IgM（1.5 UI/mL）和IgG（2.5 UI/mL）呈阳性。该患者被诊断为CMV心肌炎导致的心脏功能不全。他接受了更昔洛韦治疗10天并接受了支持性药物治疗。
该病例再次证实了CMV感染累及心脏的可能性，并强调了病毒病因作为急性心肌炎鉴别诊断的重要性。
