{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T23:00:11Z","timestamp":1762642811187,"version":"3.41.2"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T00:00:00Z","timestamp":1672876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>A global outbreak of the human monkeypox virus (HMPXV), first identified in May 2022, was declared a health emergency of international concern on 23 July 2022. Before the global outbreak, monkeypox cases were mostly confined to central and west African countries, where this virus is prevalent. Close contact, mainly sexual contact, is supposed to be the main route of transmission, and it is remarkable that the incidence is higher in men who have sexual relationships with other men.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case summary<\/jats:title><jats:p>A 40-year-old Caucasian man arrived at the emergency department complaining of oppressive epigastric pain extending to the chest after a diagnosis of pharyngitis, which was suspected to be caused by the human monkeypox virus. Based on the clinical symptoms, physical examination, serum cardiac biomarkers, and electrocardiographic findings, he was diagnosed with myopericarditis. The real-time PCR for human monkeypox in skin lesions, urine, plasma, and the oropharyngeal swab was positive. The peak of troponin I was 20.6 ng\/ml, and the electrocardiogram showed an upward concavity in the ST segment in diffuse leads, which was in agreement with the previous diagnosis. The presence of edema, subepicardial, and myocardial late gadolinium enhancement, and increased values on T1 mapping in the cardiac MRI were in agreement with the diagnosis of myopericarditis. Antiviral treatment with tecovirimat was started with excellent tolerability. After 6 days, the patient recovered and was discharged.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>To our knowledge, this is one of the first reported cases of myopericarditis due to human monkeypox infection, which was confirmed by a cardiac MRI following modified Lake Louise criteria. The short span between the onset of the mucocutaneous symptoms and the myocardial damage suggests a pathogenic association. Furthermore, the active viral replication in plasma samples and the negative results on real-time PCR for other viruses support this clinical association.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.1046498","type":"journal-article","created":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T19:56:32Z","timestamp":1672948592000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Case report: From monkeypox pharyngitis to myopericarditis and atypical skin lesions"],"prefix":"10.3389","volume":"9","author":[{"given":"Mar\u00eda Ascensi\u00f3n","family":"Sanrom\u00e1n Guerrero","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena Hern\u00e1ndez","family":"S\u00e1nchez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bel\u00e9n de Nicol\u00e1s","family":"Ruanes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo","family":"Fern\u00e1ndez-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia Anto\u00f1ana","family":"Ugalde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandra Gonz\u00e1lez","family":"Leal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcelo Sanmart\u00edn","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Javier Alarc\u00f3n","family":"Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Martinez Garcia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa","family":"Escudero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria \u00c1ngeles Fern\u00e1ndez","family":"M\u00e9ndez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Luis","family":"Zamorano G\u00f3mez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz Montero","family":"Llorente","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Jes\u00fas","family":"Vivancos-Gallego","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1056\/NEJMoa2207323","article-title":"Monkeypox virus infection in humans across 16 countries April-June 2022","volume":"387","author":"Thornhill John","year":"2022","journal-title":"N Engl J Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/S0140-6736(22)01436-2","article-title":"Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study","volume":"400","author":"Tar\u00edn-Vicente","year":"2022","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1007\/978-1-60761-817-1_15","article-title":"Detection of human-pathogenic poxviruses","volume":"665","author":"Kurth","year":"2011","journal-title":"Methods Mol Biol."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccas.2022.08.033","article-title":"Acute myocarditis - a new manifestation of monkeypox infection?","author":"Pinho","year":"2022","journal-title":"J Am Coll Cardiol Case Rep"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofac394","article-title":"Atypical clinical presentation of monkeypox complicated by myopericarditis","volume":"9","author":"Tan","year":"2022","journal-title":"Open Forum Infect Dis."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2508","DOI":"10.3201\/eid2812.221276","article-title":"Myocarditis attributable to monkeypox virus infection in 2 patients, Unites States, 2022","volume":"28","author":"Rodriguez-Nava","year":"2022","journal-title":"Emerg Infect Dis."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2636","DOI":"10.1093\/eurheartj\/eht210","article-title":"Current state of knowledge on aetiology, diagnosis, management, and therapy of miocarditis: a position Statement of the European Society of Cardiology Working group on Myocardial and Pericardial diseases","volume":"34","author":"Calaforio","year":"2013","journal-title":"Eur Heart J."},{"key":"B8","doi-asserted-by":"publisher","first-page":"3158","DOI":"10.1016\/j.jacc.2018.09.072","article-title":"Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations","volume":"72","author":"Ferreira","year":"2018","journal-title":"J Am Coll Cardiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"ofac377","DOI":"10.1093\/ofid\/ofac377","article-title":"Tecovirimat for the treatment of human monkeypox: an initial series from Massachusetts, United States","volume":"9","author":"Matias","year":"2022","journal-title":"Open Forum Infect Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1056\/NEJMp2210125","article-title":"Tecovirimat and treatment of MPX-Past, present and future considerations","volume":"387","author":"Sherwart","year":"2022","journal-title":"N Engl J Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1056\/NEJMoa1705688","article-title":"Oral tecovirimat for the treatment of smallpox","volume":"379","author":"Laudisoit","year":"2018","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e2215336","DOI":"10.1001\/jama.2022.15336","article-title":"Compassionate use of tecovirimat for the treatment of monkeypox infection","volume":"22","author":"Desai","year":"2022","journal-title":"JAMA."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/S0166-3542(02)00196-1","article-title":"Potential antiviral therapeutics for smallpox, MPX and other Orthopoxvirus infections","author":"Baker","year":"2003","journal-title":"Antiviral Res."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1007\/s40265-018-0967-6","article-title":"Tecovirimat: first global approval","volume":"78","author":"Hoy","year":"2018","journal-title":"Drugs"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e0118283","DOI":"10.1371\/journal.pone.0118283","article-title":"A prospective study of the incidence of myocarditis\/pericarditis and new onset cardiac symptoms following smallpox and influenza vaccination","volume":"10","author":"Engler","year":"2015","journal-title":"PLoS ONE."},{"key":"B16","doi-asserted-by":"publisher","first-page":"4048","DOI":"10.1016\/j.vaccine.2008.05.044","article-title":"US Military service members vaccinated against smallpox in 2003 and 2004 experience a slightly higher risk of hospitalization postvaccination","volume":"26","author":"Jacobson","year":"2008","journal-title":"Vaccine."},{"key":"B17","doi-asserted-by":"publisher","first-page":"S242","DOI":"10.1086\/524747","article-title":"Myocarditis, pericarditis, and dilated cardiomyopathy after smallpox vaccination among civilians in the United States, January-October 2003","volume":"46","author":"Morgan","year":"2008","journal-title":"Clin Infect Dis."},{"key":"B18","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1378\/chest.49.3.333","article-title":"Cardiac complications of progressive generalized vaccinia: report of a case","volume":"49","author":"McNalley","year":"1966","journal-title":"Dis Chest."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000165631","article-title":"Postvaccinal myocarditis","volume":"30","author":"Bengtsson","year":"1957","journal-title":"Cardiologia."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1086\/651453","article-title":"Kinetics of serum cytokines after primary or repeat vaccination with the smallpox vaccine","volume":"201","author":"Cohen","year":"2010","journal-title":"J Infect Dis."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.1046498\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T19:56:37Z","timestamp":1672948597000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.1046498\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,5]]},"references-count":20,"alternative-id":["10.3389\/fcvm.2022.1046498"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2022.1046498","relation":{},"ISSN":["2297-055X"],"issn-type":[{"type":"electronic","value":"2297-055X"}],"subject":[],"published":{"date-parts":[[2023,1,5]]},"article-number":"1046498"}}