Acute onset myopericarditis as unusual presentation of primary HIV infection.
A 30-year-old man was admitted to hospital after complaining of a retrosternal burning pain, radiating to the jugular region, and to both upper limbs. An electrocardiography examination showed a ST segment elevation involving the lower-lateral leads. A trans-thoracic ultrasonography showed findings compatible with an acute myopericarditis. All performed serological testings excluded other recent infections with cardiac tropism. Among screening tests, a peripheral lymphocyte subset analysis was performed and an inversion of the CD4/CD8 ratio was found. Therefore, HIV testing was performed and proved positive for HIV-1 antibodies. The discovery of a primary HIV infection with involvement of a vital organ led us to start HAART. On day 20, our patient underwent a right heart catheterization and endomyocardial biopsy. During the following days, the clinical conditions of our patient improved, and a further heart ultrasonography documented a mild pericardial thickening as a result of the recent myopericarditis. Also the evolving changes of ECG were compatible with a benign evolution of myopericarditis. The histopathologic studies revealed a mild fibrosis of the myocardial right ventricular tissue, and inflammatory findings compatible with a recent myocarditis. At the real-time PCR analysis on bioptic sample, only HHV6 DNA and HIV-DNA were reactive. An immunofluorescence staining was performed to highlight the HIV p24 protein and a positive signal was detected in myocardial tissue. Considering the low avidity level of the anti-HIV IgG antibodies and the positivity of HIV-DNA in the endomyocardial tissue, we believe that the clinical manifestation presented can be referred to the recent primary HIV-infection.
1 Department of Medical Sciences and Surgery, Section of Infectious Diseases, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
Giacomo
G
Vandi
1 Department of Medical Sciences and Surgery, Section of Infectious Diseases, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
Leonardo
L
Calza
1 Department of Medical Sciences and Surgery, Section of Infectious Diseases, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
Nicolò
N
Girometti
1 Department of Medical Sciences and Surgery, Section of Infectious Diseases, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
Roberto
R
Manfredi
2 Clinical and Experimental Medicine, Unit of Microbiology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
Giuseppina
G
Musumeci
2 Clinical and Experimental Medicine, Unit of Microbiology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
Isabella
I
Bon
2 Clinical and Experimental Medicine, Unit of Microbiology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
Maria Carla
MC
Re
D000208:Acute Disease; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D006328:Cardiac Catheterization; D004452:Echocardiography; D004562:Electrocardiography; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009205:Myocarditis / Q000000981:diagnostic imaging* / Q000628:therapy / Q000821:virology; D010493:Pericarditis / Q000000981:diagnostic imaging* / Q000628:therapy / Q000821:virology; D060888:Real-Time Polymerase Chain Reaction; D016896:Treatment Outcome
Primary HIV infection; myocarditis; pericarditis