JACC. Case reports · 2026
Acute Myocarditis as an Immune-Mediated Complication of Mpox Infection.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Khoury Fady, Kim Jeong Hwan Jake, Baghdasaryan Eric, Nathan Ramesh, Chatterjee Dhananjay
Аннотация
BACKGROUND: Cardiac involvement is an uncommon and incompletely characterized complication of mpox infection.
CASE SUMMARY: A 32-year-old man with well-controlled HIV and polymerase chain reaction-confirmed mpox developed acute chest pain days after a vesiculopustular rash. High-sensitivity troponin I peaked at 12,717 ng/L with elevated inflammatory markers. Coronary and embolic causes were excluded. Cardiac magnetic resonance (CMR) demonstrated lateral-wall edema on T2-weighted imaging and nonischemic late gadolinium enhancement with preserved ejection fraction, satisfying the updated Lake Louise Criteria. He recovered fully with supportive care.
DISCUSSION: Mpox-associated myocarditis has predominantly been reported in young, largely immunocompetent men, including some with well-controlled HIV. The mechanism remains uncertain; immune-mediated injury and direct viral involvement both remain possible. This case underscores multiparametric CMR as a noninvasive diagnostic tool that may obviate endomyocardial biopsy in hemodynamically stable patients.
TAKE-HOME MESSAGES: Mpox can cause acute myocarditis in immunocompetent patients. Multiparametric CMR enables noninvasive confirmation and may spare selected patients from endomyocardial biopsy.
CASE SUMMARY: A 32-year-old man with well-controlled HIV and polymerase chain reaction-confirmed mpox developed acute chest pain days after a vesiculopustular rash. High-sensitivity troponin I peaked at 12,717 ng/L with elevated inflammatory markers. Coronary and embolic causes were excluded. Cardiac magnetic resonance (CMR) demonstrated lateral-wall edema on T2-weighted imaging and nonischemic late gadolinium enhancement with preserved ejection fraction, satisfying the updated Lake Louise Criteria. He recovered fully with supportive care.
DISCUSSION: Mpox-associated myocarditis has predominantly been reported in young, largely immunocompetent men, including some with well-controlled HIV. The mechanism remains uncertain; immune-mediated injury and direct viral involvement both remain possible. This case underscores multiparametric CMR as a noninvasive diagnostic tool that may obviate endomyocardial biopsy in hemodynamically stable patients.
TAKE-HOME MESSAGES: Mpox can cause acute myocarditis in immunocompetent patients. Multiparametric CMR enables noninvasive confirmation and may spare selected patients from endomyocardial biopsy.