When viral myocarditis meets thrombosis tendency: deep analysis of a complex case report
This case report presents a 43-year-old male patient with severe symptoms who was admitted due to dyspnea following physical activity, cough accompanied by fever, lower limb edema, and hemoptysis. The patient had a 20-year history of hypertension. Examinations revealed bilateral lower pulmonary arte...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1641074/full |
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| author | Qian Ding Yun Zhang Dongbei Li Wenhua Liu Jing Feng Shuang Li Wei Chen Mu Guo |
| author_facet | Qian Ding Yun Zhang Dongbei Li Wenhua Liu Jing Feng Shuang Li Wei Chen Mu Guo |
| author_sort | Qian Ding |
| collection | DOAJ |
| description | This case report presents a 43-year-old male patient with severe symptoms who was admitted due to dyspnea following physical activity, cough accompanied by fever, lower limb edema, and hemoptysis. The patient had a 20-year history of hypertension. Examinations revealed bilateral lower pulmonary artery thrombosis, a left ventricular thrombus, pulmonary infarction, and reduced left ventricular systolic function, with a lowest left ventricular ejection fraction (LVEF) of 26.5%. Genetic testing indicated the presence of methylenetetrahydrofolate reductase (MTHFR) (C677T) CT type and plasminogen activator inhibitor-1 (PAI-1) (4G/5G) 4G/5G type, while pleural fluid sequencing confirmed Epstein–Barr virus (EBV)/cytomegalovirus (CMV) infection, leading to a diagnosis of viral myocarditis. Treatment included low molecular weight heparin for anticoagulation, glucocorticoids, and measures to improve cardiac function. During treatment, the patient developed a cerebral infarction. Anticoagulation was maintained post-evaluation due to the PAI-1 mutation and was later adjusted to rivaroxaban. Following treatment, inflammatory markers and coagulation function improved, cardiac function recovered (LVEF increased to 53%), and the thrombus resolved. The combination of EBV/CMV infection with MTHFR and PAI-1 mutations synergistically induced thrombosis through the “virus-inflammation-gene” pathway. This case underscores the importance of early pathogen and genetic screening, as well as personalized anticoagulation strategies, such as substituting warfarin with rivaroxaban. The potential synergistic effect of infection and hereditary thrombophilia in multi-organ embolism warrants careful consideration. |
| format | Article |
| id | doaj-art-8fba8c36cd0a4a289b0ec0e7fc00debf |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-8fba8c36cd0a4a289b0ec0e7fc00debf2025-08-20T05:32:53ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-08-011210.3389/fcvm.2025.16410741641074When viral myocarditis meets thrombosis tendency: deep analysis of a complex case reportQian Ding0Yun Zhang1Dongbei Li2Wenhua Liu3Jing Feng4Shuang Li5Wei Chen6Mu Guo7Department of Chronic Disease Management, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Cardiology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Cardiology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Chronic Disease Management, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Chronic Disease Management, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Cardiology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Cardiology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Cardiology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, ChinaThis case report presents a 43-year-old male patient with severe symptoms who was admitted due to dyspnea following physical activity, cough accompanied by fever, lower limb edema, and hemoptysis. The patient had a 20-year history of hypertension. Examinations revealed bilateral lower pulmonary artery thrombosis, a left ventricular thrombus, pulmonary infarction, and reduced left ventricular systolic function, with a lowest left ventricular ejection fraction (LVEF) of 26.5%. Genetic testing indicated the presence of methylenetetrahydrofolate reductase (MTHFR) (C677T) CT type and plasminogen activator inhibitor-1 (PAI-1) (4G/5G) 4G/5G type, while pleural fluid sequencing confirmed Epstein–Barr virus (EBV)/cytomegalovirus (CMV) infection, leading to a diagnosis of viral myocarditis. Treatment included low molecular weight heparin for anticoagulation, glucocorticoids, and measures to improve cardiac function. During treatment, the patient developed a cerebral infarction. Anticoagulation was maintained post-evaluation due to the PAI-1 mutation and was later adjusted to rivaroxaban. Following treatment, inflammatory markers and coagulation function improved, cardiac function recovered (LVEF increased to 53%), and the thrombus resolved. The combination of EBV/CMV infection with MTHFR and PAI-1 mutations synergistically induced thrombosis through the “virus-inflammation-gene” pathway. This case underscores the importance of early pathogen and genetic screening, as well as personalized anticoagulation strategies, such as substituting warfarin with rivaroxaban. The potential synergistic effect of infection and hereditary thrombophilia in multi-organ embolism warrants careful consideration.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1641074/fullviral myocarditisEBV/CMV infectionhereditary thrombophiliamultiorgan embolismcase report |
| spellingShingle | Qian Ding Yun Zhang Dongbei Li Wenhua Liu Jing Feng Shuang Li Wei Chen Mu Guo When viral myocarditis meets thrombosis tendency: deep analysis of a complex case report Frontiers in Cardiovascular Medicine viral myocarditis EBV/CMV infection hereditary thrombophilia multiorgan embolism case report |
| title | When viral myocarditis meets thrombosis tendency: deep analysis of a complex case report |
| title_full | When viral myocarditis meets thrombosis tendency: deep analysis of a complex case report |
| title_fullStr | When viral myocarditis meets thrombosis tendency: deep analysis of a complex case report |
| title_full_unstemmed | When viral myocarditis meets thrombosis tendency: deep analysis of a complex case report |
| title_short | When viral myocarditis meets thrombosis tendency: deep analysis of a complex case report |
| title_sort | when viral myocarditis meets thrombosis tendency deep analysis of a complex case report |
| topic | viral myocarditis EBV/CMV infection hereditary thrombophilia multiorgan embolism case report |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1641074/full |
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