Fulminant myocarditis as an early presentation of SARS-CoV-2

Myocarditis is well known to be caused by viral infections such as Coxsackie virus group B, human herpes virus 6 and parvovirus B19. However, during the current emerging outbreak of SARS-CoV-2, there have been few case reports describing myocarditis as a possible presentation. In our case report we describe, early cardiac manifestations of SARS-CoV-2 in a UK District General Hospital. A 44-year-old Caucasian woman without any comorbidities presented with SARS-CoV-2 related fulminant myocarditis without initial respiratory symptoms. Patient underwent treatment with milrinone and methylprednisolone that showed reduction in myocardial inflammation and significantly improved myocardial contractility. This was then followed by a second phase of SARS-CoV-2 associated pneumonia and renal failure requiring ventilatory support and haemofiltration. Although, not described in the literature, we have found conjunctive use of milrinone and methylprednisolone effective in patient with SARS-CoV-2 fulminant myocarditis.

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Acute Pancreatitis: a late complication of dengue fever

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20180581 ◽

2018 ◽

Vol 5 (2) ◽

pp. 676 ◽

Cited By ~ 2

Author(s):

Krithika A. P. ◽

Ramya R.

Keyword(s):

Acute Pancreatitis ◽

Viral Infections ◽

Case Reports ◽

Late Complication ◽

Dengue Infection ◽

Coxsackie Virus ◽

Virus Hepatitis ◽

Hepatitis Viruses ◽

Small Series ◽

History Of

Acute pancreatitis following viral infection is rare in children. Acute pancreatitis complicating viral infections has been described in the form of isolated case reports and small series. The commonly implicated viral infections have been coxsackie virus, hepatitis viruses, mumps, varicella, herpes simplex and cytomegalovirus. However, the etio- pathogenesis of pancreatitis in viral infections remains unclear. Also, the natural history of such pancreatitis has not been adequately studied. Here we present a case of acute pancreatitis following dengue infection.

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Systematic review of case reports of antiphospholipid syndrome following infection

Lupus ◽

10.1177/0961203316640912 ◽

2016 ◽

Vol 25 (14) ◽

pp. 1520-1531 ◽

Cited By ~ 39

Author(s):

N Abdel-Wahab ◽

M A Lopez-Olivo ◽

G P Pinto-Patarroyo ◽

M E Suarez-Almazor

Keyword(s):

Systematic Review ◽

Hepatitis C ◽

Antiphospholipid Syndrome ◽

Antiphospholipid Antibodies ◽

Viral Infections ◽

Case Reports ◽

Parvovirus B19 ◽

Clinical Manifestations ◽

Cochrane Library ◽

Thromboembolic Events

Objective The objective of this study was to conduct a systematic review of case reports documenting the development of antiphospholipid syndrome or antiphospholipid syndrome-related features after an infection. Methods We searched Medline, EMBASE, Web of Science, PubMed ePubs, and The Cochrane Library – CENTRAL through March 2015 without restrictions. Studies reporting cases of antiphospholipid syndrome or antiphospholipid syndrome-related features following an infection were included. Results Two hundred and fifty-nine publications met inclusion criteria, reporting on 293 cases. Three different groups of patients were identified; group 1 included patients who fulfilled the criteria for definitive antiphospholipid syndrome (24.6%), group 2 included patients who developed transient antiphospholipid antibodies with thromboembolic phenomena (43.7%), and group 3 included patients who developed transient antiphospholipid antibodies without thromboembolic events (31.7%). The most common preceding infection was viral (55.6%). In cases that developed thromboembolic events Human immunodeficiency and Hepatitis C viruses were the most frequently reported. Parvovirus B19 was the most common in cases that developed antibodies without thromboembolic events. Hematological manifestations and peripheral thrombosis were the most common clinical manifestations. Positive anticardiolipin antibodies were the most frequent antibodies reported, primarily coexisting IgG and IgM isotypes. Few patients in groups 1 and 2 had persistent antiphospholipid antibodies for more than 6 months. Outcome was variable with some cases reporting persistent antiphospholipid syndrome features and others achieving complete resolution of clinical events. Conclusions Development of antiphospholipid antibodies with all traditional manifestations of antiphospholipid syndrome were observed after variety of infections, most frequently after chronic viral infections with Human immunodeficiency and Hepatitis C. The causal relationship between infection and antiphospholipid syndrome cannot be established, but the possible contribution of various infections in the pathogenesis of antiphospholipid syndrome need further longitudinal and controlled studies to establish the incidence, and better quantify the risk and the outcomes of antiphospholipid-related events after infection.

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PARVOVIRUS B19 INDUCED MYOCARDITIS, SIMULATING ACUTE MYOCARDIAL INFARCTION

International Journal of Advanced Research ◽

10.21474/ijar01/13689 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1351-1355

Author(s):

Harshad Rajge ◽

◽

Keshav Kale ◽

Niti Bhatwal ◽

G.R. Kane ◽

...

Keyword(s):

Parvovirus B19 ◽

Supportive Therapy ◽

Chemotherapeutic Agents ◽

Cardiac Biomarkers ◽

Coxsackie Virus ◽

Fulminant Myocarditis ◽

St Segment Elevation ◽

St Segment ◽

Diagnostic Confusion ◽

Electrocardiographic Changes

Myocarditis is an inflammation of the myocardium associated with mechanical or electrical dysfunctions that usually lead to inappropriate ventricular dilatation or hypertrophy. A number of inciting factors are known to cause myocarditis- genetic defects, viruses, bacteria, parasites, granulomatous inflammations, collagen vascular disorders, chemotherapeutic agents- to name a few. Among the viruses, Adenovirus, Coxsackie virus, Human Herpes virus six and Parvovirus B19 are the encountered pathogens. We hereby present a case of a 14 years old boy who presented with typical cardiac chest pain associated with electrocardiographic changes of ST segment elevation MI in theinferior leads. Cardiac biomarkers were elevated, adding to the diagnostic confusion of MI. On subjecting the patient to a coronary angiography, his arteries were found to be patent, directing us towards the diagnosis of myocarditis. After getting a cardiac MRI and serum tests, the diagnosis of fulminant myocarditis induced by Parvovirus B19 was made. Fortunately, the patient survived on inotropes and other supportive therapy which helped him overcome the cardiac failure.

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Efficacy and safety of intravenous immunoglobulins for the treatment of viral encephalitis: a systematic literature review

Journal of Neurology ◽

10.1007/s00415-021-10494-w ◽

2021 ◽

Author(s):

Judith N. Wagner ◽

Annette Leibetseder ◽

Anna Troescher ◽

Juergen Panholzer ◽

Tim J. von Oertzen

Keyword(s):

Systematic Review ◽

Viral Encephalitis ◽

Viral Infections ◽

Case Reports ◽

Ivig Therapy ◽

Intravenous Immunoglobulins ◽

Efficacy And Safety ◽

Serious Adverse Events ◽

Optimal Dosing ◽

Cochrane Database

Abstract Background For most viral encephalitides, therapy is merely supportive. Intravenous immunoglobulins (IVIG) have been used as a prophylactic and therapeutic approach. We conduct a systematic review on the safety and efficacy of IVIG in viral encephalitis. Methods We conducted a systematic review assessing PubMed, Cochrane Database, Biosis Previews and the ClinicalTrials.gov website to identify all reports on patients with viral encephalitis treated with IVIG as of May 31, 2019. The main outcomes assessed were therapeutic efficacy and safety. For an increased homogeneity of the population, atypical viral infections were excluded, as were reports on prophylactic IVIG use, intrathecal application of immunoglobulins, or use of antibody-enriched IVIG-preparations. Data were extracted from published studies. Descriptive statistics were used. Results We included a total of 44 studies (39 case reports). The case reports cover a total of 53 patients. Our search retrieved two prospective and three retrospective studies. These show heterogeneous results as to the efficacy of IVIG therapy. Only one study reports a significant association between IVIG-use and death (odds ratio 0.032; 95% confidence interval 0.0033–0.3024; p = 0.0027). None of the studies report significant differences in the number of serious adverse events. Conclusion Data on the efficacy of IVIG-therapy is heterogeneous. While it seems generally safe, evident superiority compared to supportive treatment has not been demonstrated so far. Future trials should also investigate the optimal dosing and timing of IVIG and their benefit in the immunosuppressed.

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Viral Encephalitis In Adults: A Narrative Review

Reviews on Recent Clinical Trials ◽

10.2174/1574887116666211118141117 ◽

2021 ◽

Vol 16 ◽

Author(s):

Siciliano Valentina ◽

Rosà Tommaso ◽

Del Vecchio Pierluigi ◽

D'Angelillo Anna ◽

Brigida Mattia ◽

...

Keyword(s):

Viral Encephalitis ◽

Viral Infections ◽

Direct Action ◽

Ventilatory Support ◽

Signs And Symptoms ◽

Altered Mental Status ◽

Poor Quality ◽

Electrolyte Disorders ◽

The Central Nervous System

: Viral infections of the central nervous system cause frequent hospitalization. The pathogenesis of viral encephalitis involves both the direct action of invading pathogens and the damage generated by the inflammatory reaction they trigger. The type of signs and symptoms presented by the patient depends on the severity and location of the ongoing inflammatory process. Most of the viral encephalitides are characterized by an acute development, fever, variable alterations in consciousness (confusion, lethargy, even coma), seizures (focal and generalized) and focal neurologic signs. The specific diagnosis of encephalitis is usually based on lumbar puncture. Cerebrospinal fluid examination should be performed in all patients unless absolutely contraindicated. Also, electroencephalogram and neuroimaging play a prominent role in diagnosis. Airway protection, ventilatory support, the management of raised intracranial pressure and correction of electrolyte disorders must be immediately considered in a patient with altered mental status. The only therapy strictly recommended is acyclovir in HSV encephalitis. The use of adjunctive glucocorticoids has poor-quality evidence in HSV, EBV, or VZV encephalitis. The role of antiviral therapy in other types of viral encephalitis is not well defined.

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Rash after measles vaccination: laboratory analysis of cases reported in São Paulo, Brazil

Revista de Saúde Pública ◽

10.1590/s0034-89102002000200006 ◽

2002 ◽

Vol 36 (2) ◽

pp. 155-159 ◽

Cited By ~ 12

Author(s):

Maria I Oliveira ◽

Suely P Curti ◽

Cristina A Figueiredo ◽

Ana MS Afonso ◽

Márcia Theobaldo ◽

...

Keyword(s):

Measles Virus ◽

Viral Infections ◽

Parvovirus B19 ◽

Study Data ◽

Laboratory Analysis ◽

Measles Vaccine ◽

Etiological Diagnosis ◽

Measles Vaccination ◽

Clinical Differential Diagnosis ◽

Rubella Vaccination

OBJECTIVE: The clinical differential diagnosis of rash due to viral infections is often difficult, and misdiagnosis is not rare, especially after the introduction of measles and rubella vaccination. A study to determine the etiological diagnosis of exanthema was carried out in a group of children after measles vaccination. METHODS: Sera collected from children with rash who received measles vaccine were reported in 1999. They were analyzed for IgM antibodies against measles virus, rubella virus, human parvovirus B19 (HPV B19) using ELISA commercial techniques, and human herpes virus 6 (HHV 6) using immunofluorescence commercial technique. Viremia for each of those viruses was tested using a polimerase chain reaction (PCR). RESULTS: A total of 17 cases of children with exanthema after measles immunization were reported in 1999. The children, aged 9 to 12 months (median 10 months), had a blood sample taken for laboratory analysis. The time between vaccination and the first rash signs varied from 1 to 60 days. The serological results of those 17 children suspected of measles or rubella infection showed the following etiological diagnosis: 17.6% (3 in 17) HPV B19 infection; 76.5% (13 in 17) HHV 6 infection; 5.9% (1 in 17) rash due to measles vaccine. CONCLUSIONS: The study data indicate that infection due to HPV B19 or HHV 6 can be misdiagnosed as exanthema due to measles vaccination. Therefore, it is important to better characterize the etiology of rash in order to avoid attributing it incorrectly to measles vaccine.

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Pancytopenia Secondary to SARS-CoV 2 Infection-A Case Reprt

10.21203/rs.3.rs-657352/v1 ◽

2021 ◽

Author(s):

Neeraj Sharma ◽

Rajat Shukla ◽

Rachna Warrier ◽

Kunal Kumar ◽

Nalin Singh ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Blood Cells ◽

Epstein Barr Virus ◽

Viral Infections ◽

Parvovirus B19 ◽

Rare Complication ◽

Elderly Male ◽

Barr Virus ◽

Immunodeficiency Virus ◽

Epstein Barr

Abstract Pancytopenia is a condition when person has low count of all three types of blood cells causing a triage of anemia, leukopenia and thrombocytopenia. It should not be considered as a disease in itself but rather the sign of a disease that needs to be further evaluated. Among the various causes, viral infections like Human Immunodeficiency Virus, Cytomegalovirus, Epstein-Barr virus and Parvovirus B19 have been implicated. Pancytopenia is a rare complication and not commonly seen in patients with COVID 19 disease. Here, we report a case of pancytopenia in previously immunocompetent elderly male patient with SARS-CoV2 infection.

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Dapagliflozin Alleviates Myocardial Inflammation by Regulating the Macrophage Polarization and Stat3-related Pathways in Coxsackie Virus B3-induced Acute Viral Myocarditis

10.21203/rs.3.rs-1200173/v1 ◽

2022 ◽

Author(s):

Pengcheng Yan ◽

Xiaoning Song ◽

Joanne Tran ◽

Runfa Zhou ◽

Xinran Cao ◽

...

Keyword(s):

Cardiac Tissue ◽

Inflammatory Diseases ◽

Macrophage Polarization ◽

Viral Myocarditis ◽

Coxsackie Virus ◽

Myocardial Inflammation ◽

Protective Effects ◽

Acute Viral Myocarditis ◽

Cvb3 Infection ◽

Coxsackie Virus B3

Abstract Viral myocarditis (VMC), which is most prevalently caused by Coxsackievirus B3 (CVB3) infection, is a serious clinical condition characterized by cardiac inflammation. Dapagliflozin, a kind of sodium glucose co-transporters 2(SGLT-2) inhibitor, exhibited protective effects on plenty of inflammatory diseases, while its effect on viral myocarditis has not been studied. Recently we found the protective effect of dapagliflozin on VMC. After CVB3 infection, dapagliflozin were given orally to Balb/c male mice for 8 days and then the severity of myocarditis was assessed. Our results indicated that dapagliflozin significantly alleviated the severity of viral myocarditis, elevated the survival rate, and ameliorated cardiac function. Besides, dapagliflozin can decrease the level of proinflammatory cytokines included IL-1β, IL-6, TNF-α. Furthermore, dapagliflozin can inhibit macrophages differentiate to classically activated macrophages (M1) in cardiac tissue and activate the Stat3 signal pathway which is reported to promote polarization of the alternatively activated macrophage (M2). In conclusion, our study demonstrates that dapagliflozin alleviates myocardial inflammation by regulating the macrophage polarization and Stat3-related pathways in coxsackie virus B3-induced acute viral myocarditis.

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Acute respiratory failure as presentation of late-onset Pompe disease complicating the diagnostic process as a labyrinth: a case report

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2018.176 ◽

2018 ◽

Vol 13 ◽

Author(s):

Francesco Menzella ◽

Luca Codeluppi ◽

Mirco Lusuardi ◽

Carla Galeone ◽

Franco Valzania ◽

...

Keyword(s):

Case Report ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Pompe Disease ◽

Late Onset ◽

Correct Diagnosis ◽

Ventilatory Support ◽

Diagnostic Process ◽

Caucasian Woman ◽

Enzyme Replacement

Background: Acute respiratory failure can be triggered by several causes, either of pulmonary or extra-pulmonary origin. Pompe disease, or type II glycogen storage disease, is a serious and often fatal disorder, due to a pathological accumulation of glycogen caused by a defective activiy of acid α-glucosidase (acid maltase), a lysosomal enzyme involved in glycogen degradation. The prevalence of the disease is estimated between 1 in 40,000 to 1 in 300,000 subjects. Case presentation: This case report describes a difficult diagnosis of late-onset Pompe disease (LOPD) in a 52 year old Caucasian woman with acute respiratory failure requiring orotracheal intubation and subsequent tracheostomy for long-term mechanical ventilation 24 h/day. Despite a complex diagnostic process including several blood tests, bronchoscopy with BAL, chest CT, brain NMR, electromyographies, only a muscle biopsy allowed to reach the correct diagnosis. Discussion: The most frequent presentation of myopathies, including LOPD, is proximal limb muscle weakness. Respiratory related symptoms (dyspnea on effort, reduced physical capacity, recurrent infections, etc.) and respiratory failure are often evident in the later stages of the diseases, but they have been rarely described as the onset symptoms in LOPD. In our case, a third stage LOPD, the cooperation between pulmonologists and neurologists was crucial in reaching a correct diagnosis despite a very complex clinical scenario due to different confounding co-morbidities as potential causes of respiratory failure and an atypical presentation. In this patient, enzyme replacement therapy with infusion of alglucosidase alfa was associated with progressive reduction of ventilatory support to night hours, and recovery of autonomous walking.

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Hepatitis and Meningoencephalitis due to Enterovirus in a Toddler

Internal Medicine And Medical Investigation Journal ◽

10.24200/imminv.v2i4.133 ◽

2018 ◽

Vol 3 (1) ◽

pp. 43

Author(s):

Mohammad Ali Raza Qizalbash ◽

Rida Zahra ◽

Adnan Adil Mithwani ◽

Anwar Adil Mithwani ◽

Muaaz Adil Mithwani

Keyword(s):

Acute Hepatitis ◽

Clinical Picture ◽

Clinical Presentation ◽

Viral Infections ◽

Coxsackie Virus ◽

Watery Diarrhea ◽

Case Presentation

Background: Acute hepatitis caused by viral organisms which are typically implicated in the cases of encephalitis are rarely reported in literature. The presentation of enteroviral meningoencephalitis predominated with the clinical picture of hepatitis has rarely been recorded in populations other than neonates. Case Presentation: A male 2-year-old, presenting with a fever of 38 to 40 °C with chills and rigors, lethargy and drowsiness for 6 days. Along with the nausea, vomiting and watery diarrhea, he developed mouth ulcers (peri-oral vesicles) during the stay at the hospital. After extensive workup he was later diagnosed with meningoencephalitis and acute hepatitis due to Coxsackie virus A. After a stay of more than a month he was successfully treated and discharge. Conclusion: A more thorough evaluation should be carried out for atypical viral infections presenting with clinical presentation of hepatitis and meningoencephalitis.

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