title: Heart failure due to cytomegalovirus myocarditis in immunocompetent young adults: a case report.
abstract: BACKGROUND
  Cardiac complications constitute a rare clinical manifestation of cytomegalovirus (CMV) infection. This virus is usually asymptomatic in immunocompetent individuals. We report a case of myocarditis and cardiac insufficiency due to primary CMV infection. Serological tests by using ELISA method showed positive results for the virus.
  
  
  METHODS
  A 41-year-old man with no prior comorbidities presenting with dyspnoea, fever, and oedema was admitted to the cardiac emergency service. He had fever and dry cough, which aggravated into progressive respiratory distress, lower limb oedema, and orthopnoea 30 days prior to hospitalisation. The electrocardiogram revealed sinus tachycardia, first-degree right bundle branch block, and ventricular and left atrial overload as well as diffuse and nonspecific disturbances of ventricular repolarization. Serological tests were conducted, and IgM (1.54 UI/mL) and IgG (2.5 UI/mL) were found positive only for CMV by using ELISA. The patient was diagnosed with cardiac insufficiency due to CMV myocarditis. He was treated with ganciclovir for 10 days and received supportive medication.
  
  
  CONCLUSIONS
  This case reaffirms the possibility of cardiac involvement in CMV infection and emphasises the importance of viral aetiologies as differential diagnoses for acute myocarditis.
authors: Section of Urgency and Emergency, Division of Cardiology, Department of Intensive Care, Fundação Pública Estadual Hospital de Clínicas Gaspar Vianna, 2000 Alferes Costa street, Pedreira, 66087-660, Belém, PA, Brazil. palmeiramm@ig.com.br.|Section of Urgency and Emergency, Division of Cardiology, Department of Clinical Care, Universidade do Estado do Pará, 2623 Perebebuí street, Marco, 66087-670, Belém, PA, Brazil. palmeiramm@ig.com.br.|, 60 Amazonas square, Jurunas, 66025-070, Belém, PA, Brazil. palmeiramm@ig.com.br.
authors: Moacyr
authors: M
authors: Magno Palmeira
authors: Section of Urgency and Emergency, Division of Cardiology, Department of Clinical Care, Universidade do Estado do Pará, 2623 Perebebuí street, Marco, 66087-670, Belém, PA, Brazil.
authors: Hellen Yuki
authors: HY
authors: Umemura Ribeiro
authors: Section of Urgency and Emergency, Division of Cardiology, Department of Clinical Care, Universidade do Estado do Pará, 2623 Perebebuí street, Marco, 66087-670, Belém, PA, Brazil.
authors: Yan
authors: Y
authors: Garcia Lira
authors: Section of Urgency and Emergency, Division of Cardiology, Department of Clinical Care, Universidade do Estado do Pará, 2623 Perebebuí street, Marco, 66087-670, Belém, PA, Brazil.
authors: Fernando Octávio
authors: FO
authors: Machado Jucá Neto
authors: Section of Urgency and Emergency, Division of Cardiology, Department of Clinical Care, Universidade do Estado do Pará, 2623 Perebebuí street, Marco, 66087-670, Belém, PA, Brazil.
authors: Ivone Aline
authors: IA
authors: da Silva Rodrigues
authors: Section of Urgency and Emergency, Division of Cardiology, Department of Clinical Care, Universidade do Estado do Pará, 2623 Perebebuí street, Marco, 66087-670, Belém, PA, Brazil.
authors: Letícia Nazareth
authors: LN
authors: Fernandes da Paz
authors: Section of Human Pathology, Division of Tropical Diseases, Department of Infectious Diseases, Universidade Federal do Pará, 92 Generalíssimo Deodoro avenue, 66055-240, Umarizal, PA, Brazil.
authors: Maria da Conceição
authors: Mda C
authors: Nascimento Pinheiro
mesh_terms: D000328:Adult; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D004562:Electrocardiography; D015774:Ganciclovir / Q000627:therapeutic use; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007121:Immunocompetence; D008099:Liver / Q000201:enzymology; D008297:Male; D009205:Myocarditis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000821:virology*; D013902:Radiography, Thoracic; D055815:Young Adult
chemical_list: D015774:Ganciclovir
keywords: Cytomegalovirus infection; Heart disease; Myocarditis