A case of coxsackie B virus infection leading to multi-organ inflammation: Myopericarditis and acute liver failure

Myopericarditis refers to the development of acute pericarditis with myocardial involvement. Viral infections, including Coxsackie B virus, are amongst the most common causes of myopericarditis. The Coxsackie B viruses are known to have a role in the development of a number of clinical diseases including but not limited to cardiac disease, central nervous system infections, ocular infections, pleurodynia, gastrointestinal disease, and viral exanthems. In individual cases, Coxsackie B virus may also be associated with acute hepatitis. We describe a rare case of a 41 year-old female with multi-organ inflammation caused by Coxsackie B virus leading to myopericarditis, pleuritis, and acute liver failure. Laboratory and imaging data helped to make diagnosis of myopericarditis and appropriate management was initiated. Shortly after the patient developed acute liver failure with an INR greater than 13 and AST and ALT of 7946 u/L and 5684 u/L, respectively. Viral serology revealed Coxsackie B 1, 2, and 6 serum antibody positivity (> 1:32 titer) indicating acute or recent infection. A complete workup for other liver failure etiologies was negative. The case shows the significance of awareness and recognition of the possible complications of Coxsackie B virus infection including liver failure.