Multiple Organ Failure Associated With Coxsackie Virus in a Kidney Transplant Patient: Case Report.
Viral myocarditis can emerge with various symptoms, including fatal arrhythmia and cardiogenic shock, potentially evolving in chronic myocarditis or dilatative cardiomyopathy. We report a case of a kidney transplant patient affected by coxsackie viral myocarditis.



A 49-year-old man was admitted to our hospital with dyspnea and fever in August 2014. He underwent living donor kidney transplantation in 1986 and polar graft resection for papillary carcinoma in 2012.



The initial investigation showed pulmonary congestion, pancreatitis, increased serum troponin I, and increased liver enzyme levels. Echocardiogram revealed an ejection fraction (EF) of 20% and PAPS 45 mm Hg. He underwent coronary stent implantation, started hemodialysis, and continued on low-dose steroid immunosuppressive therapy. The clinical course improved rapidly, but endomyocardial biopsy showed acute myocarditis. Further investigation revealed a high antibody titer against coxsackievirus B4 and B5. Pancreatic enzyme levels normalized 2 months after patient admission; his cardiac condition improved after 6 months. The patient has been followed for 1 year, and his left ventricular EF is stable (45%).



Viral myocarditis represents a serious clinical condition requiring a fast therapeutic intervention. This patient's clinical course suggests that changes in his immunosuppressive therapy were associated with progressive amelioration of his viral myocarditis.
Department of General Surgery and Transplantation "P. Stefanini", Sapienza University of Rome, Italy. Electronic address: renzopretagostini@hotmail.it.
R
R
Pretagostini
Department of General Surgery and Transplantation, San Salvatore Hospital, L'Aquila University, L'Aqulia, Italy.
Q
Q
Lai
Department of General Surgery and Transplantation "P. Stefanini", Sapienza University of Rome, Italy.
L
L
Pettorini
Department of General Surgery and Transplantation "P. Stefanini", Sapienza University of Rome, Italy.
M
M
Garofalo
Department of General Surgery and Transplantation "P. Stefanini", Sapienza University of Rome, Italy.
L
L
Poli
Department of General Surgery and Transplantation "P. Stefanini", Sapienza University of Rome, Italy.
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F
Melandro
Department of General Surgery and Transplantation "P. Stefanini", Sapienza University of Rome, Italy.
G M
GM
Montalto
Department of General Surgery and Transplantation "P. Stefanini", Sapienza University of Rome, Italy.
P B
PB
Berloco
D000208:Acute Disease; D001706:Biopsy; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003384:Coxsackievirus Infections / Q000150:complications / Q000175:diagnosis*; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color; D005334:Fever / Q000209:etiology; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology; D015607:Stents; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis*