Sanromán Guerrero María Ascensión, Sánchez Elena Hernández, Ruanes Belén de Nicolás, Fernández-González Pablo, Ugalde Sonia Antoñana, Leal Alejandra González, Fernández Marcelo Sanmartín, Rodríguez Jose Javier Alarcón, Martinez Garcia Laura, Escudero Rosa, Méndez Maria Ángeles Fernández, Zamorano Gómez Jose Luis, Llorente Beatriz Montero, Vivancos-Gallego Maria Jesús
Department of Cardiology Medicine, Hospital Ramón y Cajal, Madrid, Spain.
Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain.
Front Cardiovasc Med. 2023 Jan 5;9:1046498. doi: 10.3389/fcvm.2022.1046498. eCollection 2022.
A 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.
A 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.
To 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.
2022年5月首次发现的人类猴痘病毒（HMPXV）全球暴发，于2022年7月23日被宣布为国际关注的突发公共卫生事件。在全球暴发之前，猴痘病例大多局限于该病毒流行的中非和西非国家。密切接触，主要是性接触，被认为是主要传播途径，值得注意的是，与其他男性发生性关系的男性发病率更高。
一名40岁的白种男性因诊断为咽炎后出现上腹部压迫性疼痛并放射至胸部而到急诊科就诊，怀疑是由人类猴痘病毒引起的。根据临床症状、体格检查、血清心脏生物标志物和心电图检查结果，他被诊断为心肌心包炎。皮肤病变、尿液、血浆和口咽拭子的人类猴痘实时聚合酶链反应（PCR）呈阳性。肌钙蛋白I峰值为20.6 ng/ml，心电图显示广泛导联ST段呈上凹形，与先前诊断一致。心脏磁共振成像（MRI）中存在水肿、心外膜下和心肌晚期钆增强以及T1映射值升高与心肌心包炎的诊断一致。开始使用特考韦瑞进行抗病毒治疗，耐受性良好。6天后，患者康复出院。
据我们所知，这是首批报告的因人类猴痘感染导致心肌心包炎的病例之一，根据改良的路易斯湖标准通过心脏MRI确诊。黏膜皮肤症状出现与心肌损伤之间的时间间隔较短提示存在致病关联。此外，血浆样本中活跃的病毒复制以及其他病毒实时PCR检测结果为阴性支持了这种临床关联。
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