Clinicians in Portugal say a 31-year-old man with confirmed monkeypox developed acute myocarditis roughly 1 week after the eruption of the characteristic skin lesions of the disease.

“This case highlights cardiac involvement as a potential complication associated with monkeypox infection,” Ana Isabel Pinho, MD, Department of Cardiology, São João University Hospital Centre in Porto, said in a news release.

“We 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,” Pinho adds.

Pinho and colleagues describe the case in a report published today in JACC: Case Reports.

Case Details

The patient presented with a 5-day history of malaise, myalgias, and fever followed by the eruption of multiple swollen skin lesions on his face, hands, and genitalia.

Monkeypox was confirmed by positive polymerase chain reaction assay of a swab sample from a skin lesion.

Three days later, the patient developed chest tightness that radiated through the left arm and that awoke him during the night. He was admitted to an intensive care unit with clinical suspicion of acute myocarditis.

The patient’s initial electrocardiogram showed sinus rhythm with nonspecific ventricular repolarization abnormalities.

On chest x-ray, the cardiothoracic index was normal, with no interstitial infiltrates, pleural effusion, or masses. On transthoracic echocardigraphy, biventricular systolic function was preserved, and there was no pericardial effusion.

Routine laboratory tests revealed elevated levels of C-reactive protein, creatine phosphokinase, high-sensitivity troponin I, and brain natriuretic peptide, suggesting stress injury to the heart.

Findings on cardiac magnetic resonance were consistent with myocardial inflammation and acute myocarditis.

The patient was treated with supportive care, and he made a full clinical recovery. He was discharged after 1 week. On discharge, cardiac enzymes were within the normal range. The patient showed sustained electric and hemodynamic stability, and the skin lesions had healed.

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

“I commend the authors on this valuable clinical case during a critical time as monkeypox continues to spread globally,” Grapsa added.

The researchers say further research is needed to identify the pathologic mechanism underlying monkeypox-associated cardiac injury.

By the Numbers

According to the latest data, California has reported 3629 cases, followed closely by New York with 3367 cases, Florida with 1957 cases, Texas with 1698, Georgia with 1418, and Illinois with 1081. The other states have reported fewer than 600 cases.

The CDC says that globally, more than 52,000 monkeypox cases have been reported.

Monkeypox case counts appear to be slowing in the US and globally.

Last week, the World Health Organization said the number of new cases worldwide declined by 21% between August 15 to 21 after increasing for 4 straight weeks.

The research had no funding. Pinho and colleagues have disclosed no relevant financial relationships.

JACC Case Rep. Published online September 2, 2022. Abstract

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