Myopericarditis during acute Epstein-Barr virus infection: A case report

INTRODUCTION: Complications associated with infectious mononucleosis are rare, but occasionally they can occur involving hematological, neurological, cardiological and pulmological complications, as well as liver and spleen disorders, sometimes with lethal outcome. The most important cardiac complications are myocarditis and pericarditis. CASE REPORT: An 18-year-old male patient was admitted to the Departement of Infectious Diseasees with clinical picture of infectious mononucelosis, while symptoms appeared 7 days before admission. He was under observation and treatment for nineteen days when clinical, radiographic and echocardiographic findings revealed development of myopericarditis and he was transferred to the Cardiology Department. He was treated with non-steroidal antiinflammatory drugs, beta-blockers, antibiotics and other symptomatic therapy. He became afebrile 35 days after admission, and was discharged on the 50th day in good condition. DISCUSSION: Myocarditis may develop as a complication of an infectious disease, and is usually caused by a direct viral infection, as well as, toxic and autoimmune mechanisms. Myocarditis attributed to Epstein-Barr virus infection is probably caused by autoimmune mechanisms: autoantibodies activate the complement or cause cellular cytotoxicity. CONCLUSION: Myopericarditis is not a common complication of acute Epstein-Barr virus infection. Transvenous endomyocardial biopsy is an established method required for exact diagnosis. In this case it was not done, due to some technical reasons. Thus, there is a high probalitiy that this patient had myopericarditis.