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. 1993 Jul;70(1):93–95. doi: 10.1136/hrt.70.1.93

Varicella zoster myocarditis progressing to cardiomyopathy and cardiac transplantation.

A Tsintsof 1, W J Delprado 1, A M Keogh 1
PMCID: PMC1025238  PMID: 8038008

Abstract

The case of a 12 year old schoolgirl with heart failure due to varicella myocarditis is reported. Heart failure and cardiogenic shock were evident 21 days after the appearance of the rash, and cardiac transplantation was performed two weeks later. Myocarditis is a serious complication of varicella zoster infection and heart failure may be fulminant. Endomyocardial biopsy changes consistent with myocarditis were documented six days after the start of heart failure. The histological changes, however, developed into those of idiopathic dilated cardiomyopathy (with anisonucleosis and fibre width variation) over a seven day period. This case provides further evidence for the link between viral myocarditis and idiopathic cardiomyopathy and underlines the value of immediate endomyocardial biopsy in heart failure of recent onset. Cardiac transplantation led to a rapid and full recovery.

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Selected References

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  1. Al-Nakib W., Al-Kandari S., El-Khalik D. M., El-Shirbiny A. M. A randomised controlled study of intravenous acyclovir (Zovirax) against placebo in adults with chickenpox. J Infect. 1983 May;6(1 Suppl):49–56. doi: 10.1016/s0163-4453(83)94129-4. [DOI] [PubMed] [Google Scholar]
  2. Aretz H. T., Billingham M. E., Edwards W. D., Factor S. M., Fallon J. T., Fenoglio J. J., Jr, Olsen E. G., Schoen F. J. Myocarditis. A histopathologic definition and classification. Am J Cardiovasc Pathol. 1987 Jan;1(1):3–14. [PubMed] [Google Scholar]
  3. Billingham M. E., Tazelaar H. D. The morphological progression of viral myocarditis. Postgrad Med J. 1986 Jun;62(728):581–584. doi: 10.1136/pgmj.62.728.581. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Coppack S. W., Doshi R., Ghose A. R. Fatal varicella in a healthy young adult. Postgrad Med J. 1985 Jun;61(716):529–531. doi: 10.1136/pgmj.61.716.529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ettedgui J. A., Ladusans E., Bamford M. Complete heart block as a complication of varicella. Int J Cardiol. 1987 Mar;14(3):362–365. doi: 10.1016/0167-5273(87)90208-7. [DOI] [PubMed] [Google Scholar]
  6. Hobbs R. E., Pelegrin D., Ratliff N. B., Bott-Silverman C., Rincon G., Sterba R., Badhwar K. Lymphocytic myocarditis and dilated cardiomyopathy: treatment with immunosuppressive agents. Cleve Clin J Med. 1989 Sep;56(6):628–635. doi: 10.3949/ccjm.56.6.628. [DOI] [PubMed] [Google Scholar]
  7. Hosenpud J. D., McAnulty J. H., Niles N. R. Lack of objective improvement in ventricular systolic function in patients with myocarditis treated with azathioprine and prednisone. J Am Coll Cardiol. 1985 Oct;6(4):797–801. doi: 10.1016/s0735-1097(85)80485-x. [DOI] [PubMed] [Google Scholar]
  8. Keogh A. M., Billingham M. E., Schroeder J. S. Rapid histological changes in endomyocardial biopsy specimens after myocarditis. Br Heart J. 1990 Dec;64(6):406–408. doi: 10.1136/hrt.64.6.406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Latham R. D., Mulrow J. P., Virmani R., Robinowitz M., Moody J. M. Recently diagnosed idiopathic dilated cardiomyopathy: incidence of myocarditis and efficacy of prednisone therapy. Am Heart J. 1989 Apr;117(4):876–882. doi: 10.1016/0002-8703(89)90626-1. [DOI] [PubMed] [Google Scholar]
  10. Nyerges G., Meszner Z., Gyarmati E., Kerpel-Fronius S. Acyclovir prevents dissemination of varicella in immunocompromised children. J Infect Dis. 1988 Feb;157(2):309–313. doi: 10.1093/infdis/157.2.309. [DOI] [PubMed] [Google Scholar]
  11. Prober C. G., Kirk L. E., Keeney R. E. Acyclovir therapy of chickenpox in immunosuppressed children--a collaborative study. J Pediatr. 1982 Oct;101(4):622–625. doi: 10.1016/s0022-3476(82)80725-7. [DOI] [PubMed] [Google Scholar]
  12. Salvi A., Di Lenarda A., Dreas L., Silvestri F., Camerini F. Immunosuppressive treatment in myocarditis. Int J Cardiol. 1989 Mar;22(3):329–338. doi: 10.1016/0167-5273(89)90274-x. [DOI] [PubMed] [Google Scholar]
  13. Schwarz F., Mall G., Zebe H., Schmitzer E., Manthey J., Scheurlen H., Kübler W. Determinants of survival in patients with congestive cardiomyopathy: quantitative morphologic findings and left ventricular hemodynamics. Circulation. 1984 Dec;70(6):923–928. doi: 10.1161/01.cir.70.6.923. [DOI] [PubMed] [Google Scholar]
  14. Straus S. E., Ostrove J. M., Inchauspé G., Felser J. M., Freifeld A., Croen K. D., Sawyer M. H. NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. Ann Intern Med. 1988 Feb;108(2):221–237. doi: 10.7326/0003-4819-108-2-221. [DOI] [PubMed] [Google Scholar]
  15. Waagner D. C., Murphy T. V. Varicella myocarditis. Pediatr Infect Dis J. 1990 May;9(5):360–363. doi: 10.1097/00006454-199005000-00011. [DOI] [PubMed] [Google Scholar]

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