CASE REPORT article
Front. Cardiovasc. Med.
Sec. Intensive Care Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1641074
When viral myocarditis meets thrombosis tendency: Deep analysis of a complex case report
Provisionally accepted
- Shanghai Fourth People's Hospital, Shanghai, China
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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%.CT type and PAI-1 (4G/5G) 4G/5G type, while pleural fluid sequencing confirmed EBV (Epstein-Barr Virus) / CMV (Cytomegalovirus) 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 (Plasminogen Activator Inhibitor-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.
Keywords: Viral myocarditis, EBV/CMV infection, Hereditary thrombophilia, multiorgan embolism, case report
Received: 04 Jun 2025; Accepted: 05 Aug 2025.
Copyright: © 2025 Ding, Zhang, Li, Liu, Feng, Li, Chen and Guo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wei Chen, Shanghai Fourth People's Hospital, Shanghai, China
Mu Guo, Shanghai Fourth People's Hospital, Shanghai, China
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