Acute Myocarditis Caused by Coxsackie B Virus in a Patient Living With Hiv: A Case Report

Myocarditis is a disease with multifactorial etiology, and viruses are the main infectious agents associated with it. Among viruses, Coxsackie B is widely described as a direct cause of myocardial injury. In people with HIV, the risk of myocarditis is significantly increased due both to immunosuppression and direct effects of the virus on cardiac tissue. We report the case of a male patient living with HIV (PLHIV), 37 years old, diagnosed 10 years ago, on regular tenofovir, lamivudine, and dolutegravir, with undetectable viral load and CD4 = 750 cells/mm³. He sought care for precordial chest pain radiating to the back for two days, without improvement with common analgesics. Initial tests showed findings suggestive of cardiac involvement, including elevated troponin (5.17 ng/L), CK-MB of 352 ng/mL, and ECG changes with ST-segment elevation from V2 to V6 and PR-segment depression in the same leads. Cardiac MRI revealed edema and myocardial fibrosis in a non-coronary distribution in the mid anterolateral and inferolateral segments, consistent with myocarditis. Serology confirmed infection by detection of IgM for Coxsackie B virus. The patient was admitted to the ICU, treated with beta-blockers and an ACE inhibitor, with good clinical response, and was discharged after six days. Viral etiology was established as Coxsackie B, a virus frequently linked to myocarditis in young patients, especially males. HIV infection is an important risk factor for myocarditis and may also promote direct myocardial injury. This case reinforces the importance of considering myocarditis in the evaluation of chest pain in PLHIV, particularly when laboratory and ECG abnormalities are present. Cardiac MRI was essential for diagnosis and is currently considered the imaging test of choice in myocarditis workup. Early identification and appropriate management are crucial to prevent complications such as heart failure or dilated cardiomyopathy, which can impact survival.