A case study published in JACC: Case Reports featured a 31-year-old male infected with monkeypox who developed acute myocarditis approximately one week following the onset of monkeypox symptoms.
Monkeypox is part of the same family as the smallpox virus, and a common symptom is a rash on the hands, feet, face, genitals, and other body parts. Because cases are rapidly increasing in the United States, European Union, and other countries, it has been declared a public health emergency with several global health authorities recommend following monkeypox precautions. The researchers who reported this case focused on examining inflammation of the heart muscle called myocarditis, which is typically caused by a viral infection. Cardiovascular magnetic resonance or CMR mapping was used to help with the diagnosis of myocarditis.
The patient first visited a health clinic five days after experiencing monkeypox symptoms such as malaise, myalgia, fever, and lesions on different parts of the body. A PCR swab sample of a skin lesion confirmed monkeypox infection. Three days later the patient returned to the emergency department with chest tightness radiating through the left arm.
After an initial routine examination, the patient was admitted to an intensive care unit. The initial ECG revealed sinus rhythm with nonspecific ventricular repolarization abnormalities. Laboratory tests indicated elevated levels of C-reactive protein, creatine phosphokinase (CPK), high-sensitivity troponin I and brain natriuretic peptide (BNP). CMR mapping images were consistent with myocardial inflammation.
The case study highlights the importance of screening for heart disease in monkeypox patients who are at risk for cardiac disease. Dr. Ana Isabel Pinho, MD, cardiac doctor at São João University Hospital Centre and lead author explained, “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.” Closely monitoring affected patients can allow for more proactive cardiac treatment.