A 31-year-old man with confirmed monkeypox developed acute myocarditis about a week after his symptoms started, according to a case study that came out today in JACC: Case Reports.

The monkeypox virus, which causes the disease, is related to the virus that causes smallpox. It causes a rash that looks like pimples or blisters on the hands, feet, face, private parts, and other parts of the body.

Monkeypox was first seen in the EU in May 2022. It was also seen in the US and other places where it wasn’t common, and the number of cases is rising.

Inflammation of the heart muscle, called myocarditis, is usually caused by a virus.

The authors of the case study speculated that the monkeypox virus may have tropism for myocardial tissue or may induce immune-mediated harm to the heart, despite the fact that myocarditis was previously only associated with infection with the more severe smallpox virus.

“Through this important case study,” according to Julia Grapsa, MD, PhD, editor-in-chief of JACC: Case Reports, “we are developing a deeper understanding of monkeypox, viral myocarditis and how to accurately diagnose and manage this disease.” 

“The authors of this study have used CMR mapping, a comprehensive imaging tool, to help with the diagnosis of myocarditis. I commend the authors on this valuable clinical case during a critical time as monkeypox continues to spread globally.” 

The patient went to a health clinic five days after the first signs of monkeypox, which were malaise, myalgia, fever, and swollen spots on the face, hands, and genitalia. A PCR swab sample of a skin lesion was used to establish the presence of monkeypox infection. Three days later, the patient went back to the emergency room complaining of the left arm and chest pain.

Following a preliminary routine assessment, the patient was brought to an intensive care unit with the clinical suspicion of having acute myocarditis. The first ECG showed sinus rhythm with nonspecific ventricular repolarization abnormalities.

Routine laboratory tests showed elevated levels of C-reactive protein, creatine phosphokinase (CPK), high-sensitivity troponin I, and brain natriuretic peptide (BNP), all of which can indicate stress injury to the heart. The patient’s cardiac magnetic resonance (CMR) testing results supported the diagnosis of acute myocarditis and myocardial inflammation.

The principal author of the study and cardiology department chief at So Joo University Hospital Centre in Portugal, Ana Isabel Pinho, MD, remarked that the case “highlights cardiac involvement as a potential complication associated with monkeypox infection.” 

The authors “believe that reporting this potential causal relationship can raise more awareness of the scientific community and health professionals for acute myocarditis as a possible complication associated with monkeypox, and might be helpful for close monitoring of affected patients for further recognition of other complications in the future.”

The patient recovered fully after a week. The authors stated that additional study is required to determine the connection between monkeypox and cardiac damage.

Direct contact with lesions, body fluids, or breathing droplets can spread monkeypox.

Symptoms may also include fever, chills, swollen lymph nodes, respiratory issues, and muscle aches in addition to the rash.

The typical duration of symptoms after a minor infection is two to four weeks.

People who know or think they have been exposed to the virus should get vaccinated.

Image Credit: Getty

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