Alomar Talal, Liong Katerina, Alsheikh Jad, Boddupalli Deepti
Internal Medicine, Creighton University School of Medicine, Phoenix, USA.
Cureus. 2024 Jul 3;16(7):e63768. doi: 10.7759/cureus.63768. eCollection 2024 Jul.
Coxsackie B virus is primarily associated with fever, pharyngitis, and gastrointestinal symptoms, while myocarditis is rarely reported. We present a rare case of a 47-year-old male with a history of hypertension and obesity, who developed Coxsackie B virus-induced myositis, myocarditis, and polyarthralgia. The patient presented with worsening back pain radiating to his chest, migratory arthralgia, exertional dyspnea, and bilateral shoulder pain with arm weakness. Initial investigations revealed elevated creatinine kinase (CK) levels and troponin I, alongside a high white blood cell (WBC) count and C-reactive protein (CRP) levels. Given the patient's symptoms and uptrending troponin without EKG changes, there was a high concern for non-ST-elevation myocardial infarction (NSTEMI), leading to initial treatment with aspirin and IV heparin. However, further questioning revealed a recent sore throat and contact with an ill family member, prompting investigations for an infectious etiology. A viral panel confirmed Coxsackie B virus infection. The patient made a full recovery with supportive care. This case highlights the importance of considering viral causes, particularly the Coxsackie B virus, in patients presenting with muscle pain, cardiac symptoms, and joint pain. Comprehensive viral testing is crucial for early identification and appropriate management to prevent long-term complications. Understanding the mechanisms of Coxsackie B virus infection is essential for developing effective treatment strategies addressing both the viral infection and the inflammatory response.
柯萨奇B病毒主要与发热、咽炎和胃肠道症状相关，而心肌炎的报道较少。我们报告了一例罕见病例，一名47岁男性，有高血压和肥胖病史，发生了柯萨奇B病毒感染引起的肌炎、心肌炎和多关节痛。患者表现为背痛加重并放射至胸部、游走性关节痛、劳力性呼吸困难以及双侧肩部疼痛伴手臂无力。初步检查发现肌酸激酶（CK）水平和肌钙蛋白I升高，同时白细胞（WBC）计数和C反应蛋白（CRP）水平也升高。鉴于患者的症状以及肌钙蛋白呈上升趋势而心电图无变化，高度怀疑非ST段抬高型心肌梗死（NSTEMI），因此最初给予阿司匹林和静脉注射肝素治疗。然而，进一步询问发现患者近期有咽痛且与患病家庭成员有接触，这促使对感染病因进行调查。病毒检测证实为柯萨奇B病毒感染。患者经支持治疗后完全康复。该病例强调了对于出现肌肉疼痛、心脏症状和关节疼痛的患者，考虑病毒病因，尤其是柯萨奇B病毒的重要性。全面的病毒检测对于早期识别和恰当管理以预防长期并发症至关重要。了解柯萨奇B病毒感染的机制对于制定针对病毒感染和炎症反应的有效治疗策略至关重要。
