A 28-year-old man has had a mild fever for the past 4 days along with non-productive cough and sore throat. He then develops mild dyspnea and chest pain that is more substernal than pleuritic, but poorly localized. Two days later he is no better, and sees his physician. On physical examination, the lungs are clear to auscultation. There is a friction rub. The heart rate is regular and there are no murmurs.

Laboratory findings include:

• Hemoglobin 13.9 g/dL

• Hematocrit 42.0%

• MCV 92 fL

• Platelet count 330,000/microliter

• WBC count 7100/microliter

• CK-MB slightly elevated

• Troponin I moderately elevated

Further History

An EKG is performed and shows shows ST segment elevations.

Question 3.1 - What cardiac disease is present?

There is evidence for infection because of the fever. There is evidence for damage to the myocardium. The most common de novo cardiac infection is viral. The most common clinical manifestation of viral infection is a nonspecific febrile illness.

Question 3.2 - What are the possible infectious agents that produce these findings?

Coxsackie B viral myocarditis is not common. It most often affects neonates, children, and young adults. Males are affected 2/3 of the time. Neonates commonly have severe disease, while most older children and adults recover completely. Up to 10% of cases progress to chronic dilated cardiomyopathy.

Question 3.3 - How can you confirm the diagnosis?

Serology, PCR