Monkeypox Presenting with Myocarditis: A Case Report

Monkeypox is a zoonotic Orthopoxvirus infection primarily endemic to Central and Western Africa. In recent years, there have been global outbreaks of monkeypox, including cases with atypical cutaneous lesions. We present the case of a 25-year-old Nigerian male with left-sided chest pain and vesiculopustular lesions predominantly in the genital region. The patient was diagnosed with monkeypox infection complicated by acute myocarditis, a rare presentation. Laboratory investigations, including troponin T levels and cardiac imaging, supported the diagnosis. The patient was treated with high-dose aspirin, blood thinners, antihypertensives, and NTG for myocarditis, along with isolation to prevent transmission. The patient's symptoms resolved with-in a week, and follow-up cardiac imaging showed no sequelae of myocarditis.

Monkeypox, caused by a zoonotic Orthopoxvirus, is typically a self-limited disease with mild symptoms. However, recent outbreaks have shown cases with unusual cutaneous manifestations. Here, we describe a rare case of monkeypox presenting with myocarditis, emphasizing the importance of recognizing potential complications in infected patients.

A 25-year-old Nigerian male presented with left-sided chest pain and vesiculopustular lesions involving the face, trunk, suprapubic area, and extremities. The patient had associated fever, myalgia, and palpable bilateral inguinal lymph nodes. Considering the clinical history and examination findings, monkeypox infection was suspected.

Laboratory tests were unremarkable, except for elevated troponin T levels. The 12-lead ECG showed persistent ST elevation in anterior leads, and cardiac magnetic resonance imaging confirmed myocarditis. Coronary angiography revealed normal lumen and blood flow in arteries, ruling out coronary artery disease.

The patient received high-dose aspirin, blood thinners, antihypertensives, and NTG for acute myocarditis. Additionally, he was placed in isolation to prevent viral transmission. The patient remained hemodynamically stable throughout his hospital stay, with resolution of chest pain and normalization of troponin levels.

The patient's cutaneous lesions resolved within 21 days of isolation, and follow-up cardiac imaging after eight weeks showed no signs of myocarditis or cardiac complications.

Myocarditis is a known complication of viral infections, and viral myocarditis can be caused by direct viral injury or immune-mediated mechanisms. There have been only a few reported cases of monkey-pox-associated myocarditis. Our case adds to the limited literature on this rare complication, suggesting that monkeypox may have tropism for the myocardium or elicit an immune-mediated response [1-9].

This case highlights the potential complication of myocarditis in patients with monkeypox infection. It emphasizes the importance of monitoring patients for cardiac complications and considering monkeypox-directed treatment in affected individuals. With wider availability of tecovirimat, healthcare providers should be aware of the potential cardiac implications and follow the guidelines provided by the Centers for Disease Control and Prevention (CDC) for monkeypox treatment.

None disclosed.

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