EBV-Associated Myopericarditis

Excerpt

Epstein-Barr virus (EBV) is a widely distributed virus from the herpesvirus family (human herpesvirus 4), containing a double-stranded DNA core enclosed by proteins. EBV spreads through close contact between susceptible individuals and asymptomatic carriers of EBV. The primary source of virus transmission is through bodily fluids, primarily saliva. Instances of spread are documented in the context of stem cell and organ transplantation and blood transfusion. EBV can cause aggressive and catastrophic diseases in immunocompromised individuals, like chronic EBV disease, hemophagocytic lymphohistiocytosis, autoimmune phenomena, and some tumors (Hodgkin lymphoma, non-Hodgkin lymphoma, nasopharyngeal cancer, and Burkitt lymphoma).

Cardiovascular manifestations and sequelae from EBV infection are less common yet significant, resulting from direct toxicity (lysing of host cells or cleavage of host proteins by viral proteases) and immune-mediated cellular injury. These complications have been noted in individuals whose immune systems are compromised. Complications include dilatation of the coronary artery, aneurysm of the coronary artery, progression of coronary artery disease, myopericarditis, valvular disease, and pulmonary hypertension, among others. If not managed promptly and appropriately, fatal outcomes can occur.