PDF(Pubmed)
Abstract：
Cardiac involvement, such as myocarditis and pericarditis, can be a severe complication of monkeypox virus (mpox) infection and could be related to other co-infections with cardiac involvement. Tecovirimat is an antiviral specifically designed to inhibit smallpox infection diffusion and approved by the FDA for other Orthopoxvirus infections; its efficacy in mpox-infected patients is not well established. We present the case of a cardiac complication during mpox infection in a previously undiagnosed Lyme disease in a 42-year-old man living with HIV. Two days after the typical maculopapular rash, the patient reported a rise in body temperature up to 39 °C, chest pain without irradiation, and shortness of breath. We found an increase in troponin level, a slight reduction in ejection fraction, and grade 2 AV block (Mobitz 1 and 2) with frequent sinus pauses (the longest of 10.1 s). Given the suspicion of myopericarditis with cardiac conduction system involvement, the patient was admitted to the Intermediate Care Unit for continuous monitoring and further evaluation. Treatment included Ibuprofen 600 mg every 12 hours (bid) and colchicine 1 mg once daily for anti-inflammatory purposes. Concomitantly, treatment with tecovirimat was started at 600 mg bid for a total of 14 days. Cardiac MRI with gadolinium showed mild interstitial edema and pericardial enhancement. However, despite the clinical and laboratory resolution of the acute phase, bradycardia with episodes of AV block persisted at follow-up, suggesting the possibility of an additional etiology. Thus, the patient was investigated for Lyme disease because high-degree AV block is the most common presentation of Lyme carditis. Serological results evidenced a previous Borrelia burgdorferi senso latu. We decided to start treatment with doxycycline 100 mg every 12h, even pending the uncertainty of the role of a previous Lyme disease in determining the cardiac rhythm disturbances. At the evaluation on day 44, the patient was systemically well, and after cardiologist consultation, pace-maker implantation was not deemed indicated. This case underscores the importance of considering alternative causes of carditis when the clinical picture remains unclear or persists after the acute phase.
摘要：
心脏受累,比如心肌炎和心包炎,可能是猴痘病毒（mpox）感染的严重并发症，并且可能与心脏受累的其他共同感染有关。Tecovirimat是一种专门设计用于抑制天花感染扩散的抗病毒药物，并被FDA批准用于其他正痘病毒感染;它在受天花感染的患者中的功效尚未得到很好的确定。我们介绍了一名42岁的HIV感染者在先前未诊断的莱姆病中感染水痘期间发生心脏并发症的情况。典型斑丘疹后两天，患者报告体温上升至39°C，胸痛无照射，呼吸急促.我们发现肌钙蛋白水平升高,射血分数略有降低,和2级房室传导阻滞（Mobitz1和2），伴有频繁的窦性停顿（最长10.1s）。考虑到心肌心包炎与心脏传导系统受累，患者被送入中级护理室进行持续监测和进一步评估.治疗包括布洛芬600mg每12小时(bid)和秋水仙碱1mg每天一次用于抗炎目的。同时，以600mgbid开始使用tecovirimat治疗，共14天。钆心脏MRI显示轻度间质水肿和心包增强。然而,尽管急性期的临床和实验室分辨率，心动过缓伴房室传导阻滞发作在随访时持续存在,提示可能有额外的病因。因此，对患者进行了莱姆病调查,因为高度房室传导阻滞是莱姆病最常见的表现.血清学结果证明了以前的伯氏疏螺旋体。我们决定开始用强力霉素100毫克每12小时治疗，即使不确定以前的莱姆病在确定心律紊乱中的作用。在第44天的评估中，患者全身良好，在心脏病专家咨询后，起搏器植入不被认为是指征。此病例强调了当临床表现仍不清楚或在急性期后持续存在时，考虑心脏病的替代原因的重要性。
