medigraphic.com
Colegio de Medicina Interna de México.

2024, Number 2

<< Back Next >>

Med Int Mex 2024; 40 (2)

Multiorgan failure caused by Coxsackie B5 virus infection

Medina SF, Aguilar AD, Umaña AN, Sánchez K

Language: Spanish
References: 18
Page: 137-144
PDF size: 429.68 Kb.


ABSTRACT

Background: Clinical manifestations in patients infected with coxsackievirus B are highly variable, with most cases being asymptomatic or mild, and fewer cases presenting with symptoms of severe disease. Multiorgan involvement associated with coxsackievirus B5 is very rare.
Clinical case: A 20-year-old male patient admitted to the emergency department with jaundice, high fever, abdominal pain, and sepsis; initially treated as leptospirosis. His clinical status rapidly deteriorated to circulatory shock, pancreatitis, and acute renal failure with proteinuria. He subsequently developed acute respiratory failure, possibly due to cardiac failure secondary to viral myocarditis. He required vasoactive support, noninvasive mechanical ventilation, and admission to the intensive care unit. Coxsackie B5 virus was the most likely cause, diagnosed by IgM antibody titer nine days after admission.
Conclusions: The reported case is rare because of multiorgan involvement by Coxsackie B5 virus, which is a common cause of myocarditis and pericarditis and other organ involvement. It is a multiorgan failure of unknown cause; viral infection should be suspected. Coxsackievirus has a wide clinical variability, ranging from asymptomatic infection to life-threatening disease requiring intensive supportive care to sustain life.


REFERENCES

  1. Newland JG, Romero JR. Enteroviruses. International Encyclopediaof Public Health. Elsevier, 2008; 347-52. https://doi.org/10.1016/B978-012373960-5.00600-6.

  2. Akuzawa N, Harada N, Hatori T, Imai K, Kitahara Y, SakuraiS, et al. Myocarditis, hepatitis, and pancreatitis in apatient with coxsackievirus A4 infection: A case report.Virology J 2014; 11: 1-7. https://doi.org/10.1186/1743-422X-11-3.

  3. Persichino J, Garrison R, Krishnan R, Sutjita M. Effusiveconstrictivepericarditis, hepatitis, and pancreatitis in apatient with possible coxsackievirus B infection: a casereport 2016. BMC Infect Dis 2016; 16: 375. https://doi.org/10.1186/s12879-016-1752-3.

  4. Pretagostini R, Quirino L, Pettorini L, Garofalo M, PoliL, Melandro F, et al. Multiple organ failure associatedwith Coxsackie virus in a kidney transplant patient: CaseReport. Transplant Proc 2016; 48: 438-40. https://doi.org/10.1016/J.TRANSPROCEED.2016.02.005.

  5. Lampropoulos K, Bazoukis G, Kolyviras A, Tse G, SaplaourasA, Iliopoulos T. Pancreatitis and myocarditis coexistencedue to infection by Coxsackie B1 and B4 viruses Key ClinicalMessage. Clinical Case Rep 2018; 6: 23-26. https://doi.org/10.1002/ccr3.1277.

  6. Hopkins KA, Abdou MH, Hadi MA. Coxsackie B2 virus infectioncausing multiorgan failure and cardiogenic shock ina 42-year-old man. Texas Heart Institute J 2019; 46: 32-5.https://doi.org/10.14503/THIJ-17-6361.

  7. Valestra PK, Fornos SH, Gian J, Cunha BA. CoxsackieB5 infection in an adult with fever, truncal rash, diarrheaand splenomegaly with highly elevated ferritinlevels. IDCases 2016; 6: 14. https://doi.org/10.1016/J.IDCR.2016.08.006.

  8. Kularathna MDSV, Kularatne SAM, Pathirage M, NanayakkaraPTMA. Severe leptospirosis complicated with multiorgandysfunction successfully managed with plasma exchange:a case report. J Medical Case Rep 2021; 15: 584. https://doi.org/10.1186/S13256-021-03135-3.

  9. Coplan NL, Atallah V, Mediratta S, Bruno MS, DePasqualeNP. Cardiac, pancreatic, and liver abnormalities in a patientwith coxsackie-B infection. Am J Med 1996; 101: 325-6.https://doi.org/10.1016/S0002-9343(97)89436-3.

  10. Hunt JC, Schneider C, Menticoglou S, Herath J, BigioMR. Antenatal and postnatal diagnosis of coxsackie B4infection: Case Series. AJP Reports 2012; 2:1. https://doi.org/10.1055/S-0031-1296027.

  11. Tschöpe C, Ammirati E, Bozkurt B, Caforio ALP, Cooper LT,Felix SB, et al. Myocarditis and inflammatory cardiomyopathy:current evidence and future directions. NatureReviews Cardiol https://doi.org/10.1038/s41569-020-00435-x.

  12. Feldman AM, McNamara D. Myocarditis. N Engl JMed 2000; 343: 1388-98. https://doi.org/10.1056/NEJM200011093431908.

  13. Kühl U, Pauschinger M, Seeberg B, Lassner D, NoutsiasM, Poller W, et al. Viral persistence in the myocardium isassociated with progressive cardiac dysfunction. Circulation2005; 112: 1965-70. https://doi.org/10.1161/CIRCULATIONAHA.105.548156.

  14. Ikegami S, Jitsuiki K, Nagasawa H, Nishio R, Yanagawa Y.Suspected virus-inducing severe acute respiratory distresssyndrome treated by multimodal therapy including extracorporealmembrane oxygenation and immune modulationtherapy. Cureus 2020; 12. https://doi.org/10.7759/CUREUS.8768.

  15. Pasch A, Frey FJ. Coxsackie B viruses and the kidney -aneglected topic. Nephrol Dialysis Transplantation 2006; 21:1184-87. https://doi.org/10.1093/NDT/GFL016.

  16. Conaldi PG, Biancone L, Bottelli A, de Martino † Antonella,Camussi G, Toniolo A. Distinct pathogenic effects of group Bcoxsackieviruses on human glomerular and tubular kidneycells. J Virology 1997; 71: 9180. https://doi.org/10.1128/JVI.71.12.9180-9187.1997.

  17. Bayatpour M, Zbitnew A, Dempster G, Miller KR. Role ofcoxsackievirus B4 in the pathogenesis of acute glomerulonephritis.Can Med Assoc J 1973; 109: 873.

  18. Schlapbach LJ, Teijaro JR, Fisch P, Lin G-L, Mcginley JP,Drysdale SB, et al. Epidemiology and Immune Pathogenesisof Viral Sepsis. Front Immunol 2018; 9: 2147. https://doi.org/10.3389/fimmu.2018.02147.




2020     |     www.medigraphic.com