SHM Converge Scientific Abstract ePoster Gallery-Viral Heartbreak - A Case of Herpes Simplex Virus Myopericarditis

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This case describes a 24-year-old immunosuppressed woman with a liver transplant on tacrolimus who presented with fever, dysuria, hematuria, flank pain, and painful oral/genital ulcers, followed by pleuritic chest pain and odynophagia. Initial evaluation suggested sepsis from an ESBL E. coli UTI, and she was treated with broad-spectrum antibiotics and IV fluids. Her oral and vulvar lesions were PCR-positive for HSV-1, prompting IV acyclovir for suspected disseminated HSV infection.<br /><br />She then developed evidence of cardiac involvement: elevated troponin and BNP, nonspecific ECG changes, and TTE findings of pericardial thickening and effusion. Cardiac MRI confirmed acute myopericarditis with constrictive features. She was treated with colchicine and indomethacin, later requiring diuresis after fluid overload from sepsis resuscitation. Broad viral testing in serum (HSV, EBV, CMV, coxsackie) was negative, illustrating that serum studies may not correlate well with tissue-level disease. Myocardial biopsy, the diagnostic gold standard, was deferred because of invasiveness and clinical improvement. She improved clinically and on repeat echocardiography, completed meropenem for UTI, and was discharged on valacyclovir, indomethacin, and colchicine with close follow-up.<br /><br />Key teaching points: HSV is a rare but important cause of myopericarditis, especially in immunosuppressed patients or those with active oral/genital ulcers. Diagnosis relies on a combination of clinical suspicion, ECG, biomarkers, echocardiography, and cardiac MRI; biopsy may be required in uncertain or severe cases. Treatment generally includes NSAIDs and colchicine, with diuretics or advanced heart failure support if myocardial dysfunction causes volume overload. This case emphasizes maintaining HSV on the differential because delayed recognition can be fatal.

Asset Subtitle

Athena M. Apfel

Meta Tag

Author List Athena M. Apfel, Derek M.R. Nye, Eméfah Loccoh, Ryan E. Nelson

Category Clinical Vignettes

Concept Myopericarditis

Concept Differential Diagnosis

Concept Herpes Simplex Virus Infection

Concept Antiviral Therapy

Concept Infectious Cause

Distinguished Non-Finalist

Presenter Organization Harvard Medical School

Presenting Author Athena M. Apfel

Track Adult

Keywords

HSV myopericarditis

immunosuppressed patient

liver transplant

tacrolimus

disseminated herpes simplex

oral and genital ulcers

cardiac MRI

pericardial effusion

troponin elevation

colchicine and indomethacin

Myopericarditis

Differential Diagnosis

Herpes Simplex Virus Infection

Antiviral Therapy

Infectious Cause