title: Varicella myopericarditis mimicking myocardial infarction in a 17-year-old boy.
abstract: Varicella (chickenpox), a common childhood infection caused by the varicella-zoster virus, is self-limiting and usually benign. Although atypical manifestations of the virus are occasionally seen, it rarely presents with cardiovascular sequelae. Cardiovascular complications of varicella can include pericarditis, myocarditis, or endocarditis. Herein, we report the case of a 17-year-old boy who had varicella infection and severe chest pain. Examination revealed atypical electrocardiographic findings of pericarditis and remarkably elevated cardiac biomarker levels: peak cardiac troponin I, 37.2 ng/mL; total creatine kinase, 1,209 U/L; and creatine kinase-MB fraction, 133.6 ng/mL. After results of coronary angiography reliably excluded ischemia and myocardial infarction, the diagnosis was varicella myopericarditis. The patient was placed on a medical regimen during and after 5 days of hospitalization. In 2 weeks, he was asymptomatic, and at 6 months, he was doing well and had normal electrocardiographic and echocardiographic results.To our knowledge, cardiac enzyme elevations to these levels have not been reported in cases of cardiovascular sequelae of varicella. We discuss the diagnostic challenges of this atypical case and suggest that clinicians be aware that varicella disease is most often, but not always, benign.
authors: Division of Pediatric Cardiology, St. Joseph's Children's Hospital, Paterson, New Jersey 07503, USA.
authors: Aliva
authors: A
authors: De
authors: Dorothy
authors: D
authors: Myridakis
authors: Margot
authors: M
authors: Kerrigan
authors: Fuad
authors: F
authors: Kiblawi
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000821:virology; D002644:Chickenpox / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D003937:Diagnosis, Differential; D004562:Electrocardiography; D014645:Herpesvirus 3, Human / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D009205:Myocarditis / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D010493:Pericarditis / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D011237:Predictive Value of Tests; D019210:Troponin I / Q000097:blood
chemical_list: D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D015415:Biomarkers; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form