Fatal Epstein-Barr Virus (EBV) Myopericarditis in a Young Adult Male

Epstein-Barr virus (EBV), typically known for a self-limited infection, the "infectious mononucleosis" (IM), can rarely provoke cardiac complications. We present here a case of fatal EBV myopericarditis in a young adult recently diagnosed with IM. A 16-year-old patient, whose medical history was characterized by multiple chronic pathologic conditions, was diagnosed with IM during a hospitalization. A month after discharge, he was admitted to the hospital, where an exacerbation of chronic pericarditis was diagnosed. Then, a few hours later, the patient died. Autopsy, histologic, and microbiological examinations were performed. Internal examination demonstrated opalescent and thickened pericardium, containing 180 mL of a yellowish clear effusion. The epicardium was opalescent and thickened. Cardiac microscopical examination demonstrated a diffuse and intense inflammatory infiltrate of myocardium and pericardium, associated with focal myocyte necrosis. Qualitative real-time polymerase chain reaction, performed in the pericardial effusion, tested positive for EBV DNA. The cause of death was identified as a fatal moderate-to-severe myopericarditis caused by EBV that occurred in a young adult with multiple chronic pathologic conditions. This case report emphasizes that EBV infection should be considered as a cause of sudden death due to cardiac complications in young patients with a recent diagnosis of IM.