532 lines
No EOL
128 KiB
HTML
532 lines
No EOL
128 KiB
HTML
<?xml version="1.0" encoding="utf-8"?>
|
||
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
||
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
|
||
|
||
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
|
||
<!-- AppResources meta begin -->
|
||
<meta name="paf-app-resources" content="" />
|
||
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
||
|
||
<!-- AppResources meta end -->
|
||
|
||
<!-- TemplateResources meta begin -->
|
||
<meta name="paf_template" content="" />
|
||
|
||
<!-- TemplateResources meta end -->
|
||
|
||
<!-- Logger begin -->
|
||
<meta name="ncbi_db" content="books" /><meta name="ncbi_pdid" content="book-part" /><meta name="ncbi_acc" content="NBK599522" /><meta name="ncbi_domain" content="statpearls" /><meta name="ncbi_report" content="record" /><meta name="ncbi_type" content="fulltext" /><meta name="ncbi_objectid" content="" /><meta name="ncbi_pcid" content="/NBK599522/" /><meta name="ncbi_pagename" content="EBV-Associated Myopericarditis - StatPearls - NCBI Bookshelf" /><meta name="ncbi_bookparttype" content="chapter" /><meta name="ncbi_app" content="bookshelf" />
|
||
<!-- Logger end -->
|
||
|
||
<title>EBV-Associated Myopericarditis - StatPearls - NCBI Bookshelf</title>
|
||
|
||
<!-- AppResources external_resources begin -->
|
||
<link rel="stylesheet" href="/core/jig/1.15.2/css/jig.min.css" /><script type="text/javascript" src="/core/jig/1.15.2/js/jig.min.js"></script>
|
||
|
||
<!-- AppResources external_resources end -->
|
||
|
||
<!-- Page meta begin -->
|
||
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="StatPearls [Internet]" /><meta name="citation_title" content="EBV-Associated Myopericarditis" /><meta name="citation_publisher" content="StatPearls Publishing" /><meta name="citation_date" content="2024/01/11" /><meta name="citation_author" content="Rakesh Das" /><meta name="citation_author" content="Andrew D. Nguyen" /><meta name="citation_pmid" content="38261671" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK599522/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="EBV-Associated Myopericarditis" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="StatPearls Publishing" /><meta name="DC.Contributor" content="Rakesh Das" /><meta name="DC.Contributor" content="Andrew D. Nguyen" /><meta name="DC.Date" content="2024/01/11" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK599522/" /><meta name="description" content="Epstein-Barr virus (EBV) is a widely distributed virus from the herpesvirus family (human herpesvirus 4), containing a double-stranded DNA core enclosed by proteins.[1] EBV spreads through close contact between susceptible individuals and asymptomatic carriers of EBV. The primary source of virus transmission is through bodily fluids, primarily saliva.[2] Instances of spread are documented in the context of stem cell and organ transplantation and blood transfusion.[3] EBV can cause aggressive and catastrophic diseases in immunocompromised individuals, like chronic EBV disease, hemophagocytic lymphohistiocytosis, autoimmune phenomena, and some tumors (Hodgkin lymphoma, non-Hodgkin lymphoma, nasopharyngeal cancer, and Burkitt lymphoma).[4][5]" /><meta name="og:title" content="EBV-Associated Myopericarditis" /><meta name="og:type" content="book" /><meta name="og:description" content="Epstein-Barr virus (EBV) is a widely distributed virus from the herpesvirus family (human herpesvirus 4), containing a double-stranded DNA core enclosed by proteins.[1] EBV spreads through close contact between susceptible individuals and asymptomatic carriers of EBV. The primary source of virus transmission is through bodily fluids, primarily saliva.[2] Instances of spread are documented in the context of stem cell and organ transplantation and blood transfusion.[3] EBV can cause aggressive and catastrophic diseases in immunocompromised individuals, like chronic EBV disease, hemophagocytic lymphohistiocytosis, autoimmune phenomena, and some tumors (Hodgkin lymphoma, non-Hodgkin lymphoma, nasopharyngeal cancer, and Burkitt lymphoma).[4][5]" /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK599522/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-statpearls-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/statpearls/article-145596/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK599522/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
|
||
|
||
<!-- Page meta end -->
|
||
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico" /><meta name="ncbi_phid" content="CE8D9B0F7C7F3551000000000158010D.m_13" />
|
||
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3985586/3808861/4121862/3974050/3917732/251717/4216701/14534/45193/4113719/3849091/3984811/3751656/4033350/3840896/3577051/3852958/4008682/4207974/4206132/4062871/12930/3964959/3854974/36029/4128070/9685/3549676/3609192/3609193/3609213/3395586.css" /><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3411343/3882866.css" media="print" /></head>
|
||
<body class="book-part">
|
||
<div class="grid">
|
||
<div class="col twelve_col nomargin shadow">
|
||
<!-- System messages like service outage or JS required; this is handled by the TemplateResources portlet -->
|
||
<div class="sysmessages">
|
||
<noscript>
|
||
<p class="nojs">
|
||
<strong>Warning:</strong>
|
||
The NCBI web site requires JavaScript to function.
|
||
<a href="/guide/browsers/#enablejs" title="Learn how to enable JavaScript" target="_blank">more...</a>
|
||
</p>
|
||
</noscript>
|
||
</div>
|
||
<!--/.sysmessage-->
|
||
<div class="wrap">
|
||
<div class="page">
|
||
<div class="top">
|
||
<div id="universal_header">
|
||
<section class="usa-banner">
|
||
<div class="usa-accordion">
|
||
<header class="usa-banner-header">
|
||
<div class="usa-grid usa-banner-inner">
|
||
<img src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/favicons/favicon-57.png" alt="U.S. flag" />
|
||
<p>An official website of the United States government</p>
|
||
<button class="non-usa-accordion-button usa-banner-button" aria-expanded="false" aria-controls="gov-banner-top" type="button">
|
||
<span class="usa-banner-button-text">Here's how you know</span>
|
||
</button>
|
||
</div>
|
||
</header>
|
||
<div class="usa-banner-content usa-grid usa-accordion-content" id="gov-banner-top" aria-hidden="true">
|
||
<div class="usa-banner-guidance-gov usa-width-one-half">
|
||
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-dot-gov.svg" alt="Dot gov" />
|
||
<div class="usa-media_block-body">
|
||
<p>
|
||
<strong>The .gov means it's official.</strong>
|
||
<br />
|
||
Federal government websites often end in .gov or .mil. Before
|
||
sharing sensitive information, make sure you're on a federal
|
||
government site.
|
||
</p>
|
||
</div>
|
||
</div>
|
||
<div class="usa-banner-guidance-ssl usa-width-one-half">
|
||
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-https.svg" alt="Https" />
|
||
<div class="usa-media_block-body">
|
||
<p>
|
||
<strong>The site is secure.</strong>
|
||
<br />
|
||
The <strong>https://</strong> ensures that you are connecting to the
|
||
official website and that any information you provide is encrypted
|
||
and transmitted securely.
|
||
</p>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</section>
|
||
<div class="usa-overlay"></div>
|
||
<header class="ncbi-header" role="banner" data-section="Header">
|
||
|
||
<div class="usa-grid">
|
||
<div class="usa-width-one-whole">
|
||
|
||
<div class="ncbi-header__logo">
|
||
<a href="/" class="logo" aria-label="NCBI Logo" data-ga-action="click_image" data-ga-label="NIH NLM Logo">
|
||
<img src="https://www.ncbi.nlm.nih.gov/coreutils/nwds/img/logos/AgencyLogo.svg" alt="NIH NLM Logo" />
|
||
</a>
|
||
</div>
|
||
|
||
<div class="ncbi-header__account">
|
||
<a id="account_login" href="https://account.ncbi.nlm.nih.gov" class="usa-button header-button" style="display:none" data-ga-action="open_menu" data-ga-label="account_menu">Log in</a>
|
||
<button id="account_info" class="header-button" style="display:none" aria-controls="account_popup" type="button">
|
||
<span class="fa fa-user" aria-hidden="true">
|
||
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" width="20px" height="20px">
|
||
<g style="fill: #fff">
|
||
<ellipse cx="12" cy="8" rx="5" ry="6"></ellipse>
|
||
<path d="M21.8,19.1c-0.9-1.8-2.6-3.3-4.8-4.2c-0.6-0.2-1.3-0.2-1.8,0.1c-1,0.6-2,0.9-3.2,0.9s-2.2-0.3-3.2-0.9 C8.3,14.8,7.6,14.7,7,15c-2.2,0.9-3.9,2.4-4.8,4.2C1.5,20.5,2.6,22,4.1,22h15.8C21.4,22,22.5,20.5,21.8,19.1z"></path>
|
||
</g>
|
||
</svg>
|
||
</span>
|
||
<span class="username desktop-only" aria-hidden="true" id="uname_short"></span>
|
||
<span class="sr-only">Show account info</span>
|
||
</button>
|
||
</div>
|
||
|
||
<div class="ncbi-popup-anchor">
|
||
<div class="ncbi-popup account-popup" id="account_popup" aria-hidden="true">
|
||
<div class="ncbi-popup-head">
|
||
<button class="ncbi-close-button" data-ga-action="close_menu" data-ga-label="account_menu" type="button">
|
||
<span class="fa fa-times">
|
||
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 48 48" width="24px" height="24px">
|
||
<path d="M38 12.83l-2.83-2.83-11.17 11.17-11.17-11.17-2.83 2.83 11.17 11.17-11.17 11.17 2.83 2.83 11.17-11.17 11.17 11.17 2.83-2.83-11.17-11.17z"></path>
|
||
</svg>
|
||
</span>
|
||
<span class="usa-sr-only">Close</span></button>
|
||
<h4>Account</h4>
|
||
</div>
|
||
<div class="account-user-info">
|
||
Logged in as:<br />
|
||
<b><span class="username" id="uname_long">username</span></b>
|
||
</div>
|
||
<div class="account-links">
|
||
<ul class="usa-unstyled-list">
|
||
<li><a id="account_myncbi" href="/myncbi/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_myncbi">Dashboard</a></li>
|
||
<li><a id="account_pubs" href="/myncbi/collections/bibliography/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_pubs">Publications</a></li>
|
||
<li><a id="account_settings" href="/account/settings/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_settings">Account settings</a></li>
|
||
<li><a id="account_logout" href="/account/signout/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_logout">Log out</a></li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
|
||
</div>
|
||
</div>
|
||
</header>
|
||
<div role="navigation" aria-label="access keys">
|
||
<a id="nws_header_accesskey_0" href="https://www.ncbi.nlm.nih.gov/guide/browsers/#ncbi_accesskeys" class="usa-sr-only" accesskey="0" tabindex="-1">Access keys</a>
|
||
<a id="nws_header_accesskey_1" href="https://www.ncbi.nlm.nih.gov" class="usa-sr-only" accesskey="1" tabindex="-1">NCBI Homepage</a>
|
||
<a id="nws_header_accesskey_2" href="/myncbi/" class="set-base-url usa-sr-only" accesskey="2" tabindex="-1">MyNCBI Homepage</a>
|
||
<a id="nws_header_accesskey_3" href="#maincontent" class="usa-sr-only" accesskey="3" tabindex="-1">Main Content</a>
|
||
<a id="nws_header_accesskey_4" href="#" class="usa-sr-only" accesskey="4" tabindex="-1">Main Navigation</a>
|
||
</div>
|
||
<section data-section="Alerts">
|
||
<div class="ncbi-alerts-placeholder"></div>
|
||
</section>
|
||
</div>
|
||
<div class="header">
|
||
<div class="res_logo"><h1 class="res_name"><a href="/books/" title="Bookshelf home">Bookshelf</a></h1><h2 class="res_tagline"></h2></div>
|
||
<div class="search"><form method="get" action="/books/"><div class="search_form"><label for="database" class="offscreen_noflow">Search database</label><select id="database"><optgroup label="Recent"><option value="books" selected="selected" data-ac_dict="bookshelf-search">Books</option><option value="refseq">RefSeq</option><option value="nuccore">Nucleotide</option><option value="clinvar" class="last">ClinVar</option></optgroup><optgroup label="All"><option value="gquery">All Databases</option><option value="assembly">Assembly</option><option value="biocollections">Biocollections</option><option value="bioproject">BioProject</option><option value="biosample">BioSample</option><option value="books" data-ac_dict="bookshelf-search">Books</option><option value="clinvar">ClinVar</option><option value="cdd">Conserved Domains</option><option value="gap">dbGaP</option><option value="dbvar">dbVar</option><option value="gene">Gene</option><option value="genome">Genome</option><option value="gds">GEO DataSets</option><option value="geoprofiles">GEO Profiles</option><option value="gtr">GTR</option><option value="ipg">Identical Protein Groups</option><option value="medgen">MedGen</option><option value="mesh">MeSH</option><option value="nlmcatalog">NLM Catalog</option><option value="nuccore">Nucleotide</option><option value="omim">OMIM</option><option value="pmc">PMC</option><option value="protein">Protein</option><option value="proteinclusters">Protein Clusters</option><option value="protfam">Protein Family Models</option><option value="pcassay">PubChem BioAssay</option><option value="pccompound">PubChem Compound</option><option value="pcsubstance">PubChem Substance</option><option value="pubmed">PubMed</option><option value="snp">SNP</option><option value="sra">SRA</option><option value="structure">Structure</option><option value="taxonomy">Taxonomy</option><option value="toolkit">ToolKit</option><option value="toolkitall">ToolKitAll</option><option value="toolkitbookgh">ToolKitBookgh</option></optgroup></select><div class="nowrap"><label for="term" class="offscreen_noflow" accesskey="/">Search term</label><div class="nowrap"><input type="text" name="term" id="term" title="Search Books. Use up and down arrows to choose an item from the autocomplete." value="" class="jig-ncbiclearbutton jig-ncbiautocomplete" data-jigconfig="dictionary:'bookshelf-search',disableUrl:'NcbiSearchBarAutoComplCtrl'" autocomplete="off" data-sbconfig="ds:'no',pjs:'no',afs:'no'" /></div><button id="search" type="submit" class="button_search nowrap" cmd="go">Search</button></div></div></form><ul class="searchlinks inline_list"><li>
|
||
<a href="/books/browse/">Browse Titles</a>
|
||
</li><li>
|
||
<a href="/books/advanced/">Advanced</a>
|
||
</li><li class="help">
|
||
<a href="/books/NBK3833/">Help</a>
|
||
</li><li class="disclaimer">
|
||
<a target="_blank" data-ga-category="literature_resources" data-ga-action="link_click" data-ga-label="disclaimer_link" href="https://www.ncbi.nlm.nih.gov/books/about/disclaimer/">Disclaimer</a>
|
||
</li></ul></div>
|
||
</div>
|
||
|
||
|
||
|
||
<!--<component id="Page" label="headcontent"/>-->
|
||
|
||
</div>
|
||
<div class="content">
|
||
<!-- site messages -->
|
||
<!-- Custom content 1 -->
|
||
<div class="col1">
|
||
|
||
</div>
|
||
|
||
<div class="container">
|
||
<div id="maincontent" class="content eight_col col">
|
||
<!-- Custom content in the left column above book nav -->
|
||
<div class="col2">
|
||
|
||
</div>
|
||
|
||
<!-- Book content -->
|
||
|
||
|
||
<!-- Custom content between navigation and content -->
|
||
<div class="col3">
|
||
|
||
</div>
|
||
|
||
<div class="document">
|
||
<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/statpearls/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-statpearls-lrg.png" alt="Cover of StatPearls" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>StatPearls [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK599522_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK599522_dtls__"><div>Treasure Island (FL): <a href="https://www.statpearls.com/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">StatPearls Publishing</a>; 2025 Jan-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/statpearls/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
|
||
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK599522_"><span class="title" itemprop="name">EBV-Associated Myopericarditis</span></h1><p class="contrib-group"><span itemprop="author">Rakesh Das</span>; <span itemprop="author">Andrew D. Nguyen</span>.</p><a data-jig="ncbitoggler" href="#__NBK599522_ai__" style="border:0;text-decoration:none">Author Information and Affiliations</a><div style="display:none" class="ui-widget" id="__NBK599522_ai__"><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Rakesh Das</span><sup>1</sup>; <span itemprop="author">Andrew D. Nguyen</span><sup>2</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> Lincoln medical Center</div><div class="affiliation"><sup>2</sup> University of Queensland</div></div><p class="small">Last Update: <span itemprop="dateModified">January 11, 2024</span>.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="article-145596.s1"><h2 id="_article-145596_s1_">Continuing Education Activity</h2><p>Cardiovascular complications stemming from Epstein-Barr virus (EBV) infection, though relatively rare, carry significant implications, especially in immunocompromised individuals. These issues arise from a combination of direct viral toxicity and the immune system's response, leading to pathological changes such as myocardial necrosis and cardiac dilatation. The complications include coronary artery dilatation, coronary artery aneurysms, myopericarditis, acute myocardial infarction, valvular heart conditions, heart failure, pulmonary arterial hypertension, and more.</p><p>Left unaddressed, the complications lead to significant morbidity and mortality, underscoring the importance of timely and appropriate management. The appropriate treatment in a multidisciplinary care setting is necessary to optimize the care of patients with EBV-related myopericarditis. This activity reviews the evaluation and treatment of EBV-associated myopericarditis and highlights the role of the interprofessional team in evaluating and treating patients with this condition.</p><p>
|
||
<b>Objectives:</b>
|
||
<ul><li class="half_rhythm"><div>Identify the signs and symptoms of EBV-associated myopericarditis.</div></li><li class="half_rhythm"><div>Select appropriate investigation modalities for establishing the diagnosis of EBV-associated myopericarditis. </div></li><li class="half_rhythm"><div>Evaluate appropriate pharmacologic treatments for patients with myopericarditis caused by EBV.</div></li><li class="half_rhythm"><div>Collaborate with interprofessional team members, including specialists such as infectious disease clinicians, cardiologists, pathologists, and intensivists, and provide efficient, comprehensive, and coordinated care to patients with EBV-associated myopericarditis.</div></li></ul>
|
||
<a href="https://www.statpearls.com/account/trialuserreg/?articleid=145596&utm_source=pubmed&utm_campaign=reviews&utm_content=145596" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
|
||
</p></div><div id="article-145596.s2"><h2 id="_article-145596_s2_">Introduction</h2><p>Epstein-Barr virus (EBV) is a widely distributed virus from the herpesvirus family (human herpesvirus 4), containing a double-stranded DNA core enclosed by proteins.<a class="bk_pop" href="#article-145596.r1">[1]</a> EBV spreads through close contact between susceptible individuals and asymptomatic carriers of EBV. The primary source of virus transmission is through bodily fluids, primarily saliva.<a class="bk_pop" href="#article-145596.r2">[2]</a> Instances of spread are documented in the context of stem cell and organ transplantation and blood transfusion.<a class="bk_pop" href="#article-145596.r3">[3]</a> EBV can cause aggressive and catastrophic diseases in immunocompromised individuals, like chronic EBV disease, hemophagocytic lymphohistiocytosis, autoimmune phenomena, and some tumors (Hodgkin lymphoma, non-Hodgkin lymphoma, nasopharyngeal cancer, and Burkitt lymphoma).<a class="bk_pop" href="#article-145596.r4">[4]</a><a class="bk_pop" href="#article-145596.r5">[5]</a></p><p>Cardiovascular manifestations and sequelae from EBV infection are less common yet significant, resulting from direct toxicity (lysing of host cells or cleavage of host proteins by viral proteases) and immune-mediated cellular injury. These complications have been noted in individuals whose immune systems are compromised. Complications include dilatation of the coronary artery, aneurysm of the coronary artery, progression of coronary artery disease, myopericarditis, valvular disease, and pulmonary hypertension, among others.<a class="bk_pop" href="#article-145596.r6">[6]</a> If not managed promptly and appropriately, fatal outcomes can occur.<a class="bk_pop" href="#article-145596.r7">[7]</a></p></div><div id="article-145596.s3"><h2 id="_article-145596_s3_">Etiology</h2><p>EBV has an outer layer of glycoproteins. These are essential for binding to and infiltrating specific host cells, primarily B-cells and epithelial cells.<a class="bk_pop" href="#article-145596.r8">[8]</a> EBV mutates B-cells to duplicate genetic material. This process converts B-cells into memory B-cells, which can circulate in the bloodstream or remain inactive until an external trigger prompts the revival.<a class="bk_pop" href="#article-145596.r9">[9]</a></p><p>B lymphocytes, T lymphocytes, epithelial cells, and myocytes are host cells for EBV. Unlike herpes simplex (HSV) or cytomegalovirus (CMV), EBV transforms B-cells without causing noticeable cell damage.<a class="bk_pop" href="#article-145596.r10">[10]</a> Given the latency of EBV, host factors such as immunosuppression may lead to virus reactivation, leading to clinical manifestations such as infectious mononucleosis and autoimmune phenomena.<a class="bk_pop" href="#article-145596.r8">[8]</a><a class="bk_pop" href="#article-145596.r11">[11]</a><a class="bk_pop" href="#article-145596.r12">[12]</a><a class="bk_pop" href="#article-145596.r13">[13]</a> Immunosuppression is associated with aggressive lymphoproliferative disorders in organ transplant recipients and other immunocompromised patients, first described in observations of EBV within tissue samples of lymphoma patients.<a class="bk_pop" href="#article-145596.r8">[8]</a><a class="bk_pop" href="#article-145596.r14">[14]</a></p></div><div id="article-145596.s4"><h2 id="_article-145596_s4_">Epidemiology</h2><p>Approximately 90% to 95% of the global adult population has experienced EBV infection.<a class="bk_pop" href="#article-145596.r15">[15]</a> In the United States, one seroprevalence study estimated the prevalence of EBV among children and adolescents aged 6 to 19 to be 66.5%.<a class="bk_pop" href="#article-145596.r16">[16]</a> Specifically, children aged 6 to 8 exhibited an approximate 54% prevalence, while adolescents aged 18 to 19 displayed a prevalence of 82.9%. The Mexican-American children and adolescents in the study exhibited a higher EBV prevalence in comparison to their non-Hispanic black and white counterparts. In low and middle-income countries, the estimated population seroprevalence of EBV ranged from 92.1% to 94.8%, with the highest seropositivity in those aged >40 years.<a class="bk_pop" href="#article-145596.r17">[17]</a> In the United Kingdom, a seroprevalence study estimated an overall population prevalence of 85.3%, with females reaching seropositivity younger than males.<a class="bk_pop" href="#article-145596.r18">[18]</a> </p><p>Other findings included higher seroprevalence in those with a white ethnicity, lower body mass index, and a non-smoking history. Factors such as larger household sizes, lower household incomes, decreased parental education, early life maternal deprivation, and foreign birth are all associated with a heightened prevalence of EBV infection among children and adolescents.<a class="bk_pop" href="#article-145596.r19">[19]</a><a class="bk_pop" href="#article-145596.r16">[16]</a></p><p>Myopericarditis is infrequent in children and adolescents, with a projected occurrence rate of 1 to 2 cases per 100,000 individuals.<a class="bk_pop" href="#article-145596.r20">[20]</a> In cases of EBV associated with coronary disease, evidence is limited to observational studies or case reports, with one study of 299 patients with percutaneous coronary intervention indicating higher measures of pro-inflammatory cytokines and EBV-related proteins among all patients with acute myocardial infarctions.<a class="bk_pop" href="#article-145596.r21">[21]</a> In an anatomical study of 142 patients with cardiac dilation and histological evidence of myocarditis, 9 patients were found positive for EBV DNA.<a class="bk_pop" href="#article-145596.r22">[22]</a></p></div><div id="article-145596.s5"><h2 id="_article-145596_s5_">Pathophysiology</h2><p>The progression of viral myocarditis-induced damage unfolds in 2 distinct phases. The initial phase spans roughly 1 week and is characterized by viral infiltration into the myocardium, viral replication, and subsequent cell lysis. Neutralizing antibodies are generated, leading to the elimination or attenuation of the virus by macrophages and natural killer cells during the innate immune response.<a class="bk_pop" href="#article-145596.r23">[23]</a><a class="bk_pop" href="#article-145596.r24">[24]</a></p><p>Following this stage, the myocardium experiences an influx of inflammatory cells, accompanied by immune system activation that includes the production of antibodies targeting cardiac myocytes through an adaptive immune response driven by T cells. This phase endures for several weeks or months and is associated with varying extents of myocardial impairment, ranging from minimal to severe. Recovery may occur with the elimination of pathogens, but in susceptible individuals such as those with immune dysfunction, chronic inflammation, remodeling, dilated cardiomyopathy, and cardiac failure may occur.<a class="bk_pop" href="#article-145596.r24">[24]</a> In the murine model, characteristic pathological findings encompass multiple localized regions of myocyte loss, sheets of fibrosis, and diffusely scattered calcified deposits throughout all layers and chambers of the cardiac muscle.<a class="bk_pop" href="#article-145596.r23">[23]</a></p></div><div id="article-145596.s6"><h2 id="_article-145596_s6_">Histopathology</h2><p>Pathologically, inflammatory cell infiltrates associated with or without myocyte necrosis are required to identify myocarditis when viewing stained heart tissue sections.<a class="bk_pop" href="#article-145596.r25">[25]</a> Autoantibodies to cardiac antigens, such as cardiac myosin, may be performed. Based on the associated clinical history and prodrome, findings may be consistent with either fulminant lymphocytic myocarditis or acute lymphocytic myocarditis.<a class="bk_pop" href="#article-145596.r26">[26]</a> Therefore, findings may suggest a viral etiology on histopathology. A concordant clinical history is required to confirm viral myocarditis.</p></div><div id="article-145596.s7"><h2 id="_article-145596_s7_">History and Physical</h2><p>The clinical presentation encompasses asymptomatic conditions to abrupt fatality attributable to either fulminant heart failure or malignant ventricular arrhythmias. The clinical presentation holds notable prognostic significance, and individuals with heart failure symptoms at the outset are markedly prone to requiring transplantation and facing cardiac mortality.<a class="bk_pop" href="#article-145596.r27">[27]</a></p><p>Symptoms mostly resemble a cold, including fever, fatigue, cough, and odynophagia. Other symptoms encompass precordial chest pain, palpitations, polymyalgia, and asthenia.<a class="bk_pop" href="#article-145596.r28">[28]</a> Additionally, there is mild, non-radiating chest discomfort, breathlessness, dizziness, and decreased ability to exercise, all absent during rest.<a class="bk_pop" href="#article-145596.r29">[29]</a> The emergence of myocarditis in children and adults might be preceded by a viral prodrome characterized by symptoms like rash, myo-arthralgias, and gastrointestinal and respiratory issues, occurring anywhere from several days to a few weeks prior.<a class="bk_pop" href="#article-145596.r30">[30]</a><a class="bk_pop" href="#article-145596.r24">[24]</a><a class="bk_pop" href="#article-145596.r31">[31]</a></p><p>In cases where pericardial involvement is predominant, individuals may describe the pain as sharp, exacerbated by coughing or deep breaths, and alleviated by assuming a forward-leaning position. When there is substantial myocardial engagement, the pain might be continuous, posing challenges while distinguishing it from myocardial ischemic pain, particularly among those with cardiovascular risk factors.<a class="bk_pop" href="#article-145596.r32">[32]</a> Additionally, they might exhibit prevalent symptoms of heart failure like breathlessness, orthopnea, swelling in the lower extremities, and fatigue. Infrequent symptoms encompass arrhythmias, syncope, and sudden cardiac arrest.<a class="bk_pop" href="#article-145596.r33">[33]</a></p><p>Physical examination findings can vary but commonly include fever, a pericardial friction rub, and indications of heart failure. <a class="bk_pop" href="#article-145596.r34">[34]</a> Furthermore, enlarged cervical lymph nodes and tonsillar hypertrophy with exudates are present. Conversely, symptoms like hepatomegaly and splenomegaly are notably absent. Manifestations of systemic illness that might contribute to the underlying cause include autoimmune disorders, systemic lupus erythematosus, vaccinations, chemotherapy, and immune checkpoint inhibitor therapy.<a class="bk_pop" href="#article-145596.r35">[35]</a><a class="bk_pop" href="#article-145596.r36">[36]</a></p><p>These subtle presentations can sometimes lead to complications abruptly, escalating into life-threatening scenarios. Myopericarditis exhibits diverse progression patterns, ranging from fatal outcomes attributed to severe systolic dysfunction or ventricular arrhythmias to extended development into dilated cardiomyopathy.<a class="bk_pop" href="#article-145596.r37">[37]</a> Upon discharge from inpatient care, vigilant monitoring for several weeks is imperative, especially in cases where the possibility of heart failure development persists.</p></div><div id="article-145596.s8"><h2 id="_article-145596_s8_">Evaluation</h2><p>
|
||
<b>Laboratory Studies</b>
|
||
</p><p>Atypical lymphocytosis is typically evident in peripheral smears.<a class="bk_pop" href="#article-145596.r8">[8]</a> Serological testing is generally used to ascertain whether a patient has exposure to EBV. Routine viral serology tests are not typically beneficial for the diagnostic process, as their outcomes seldom influence treatment decisions. In determining acute infection with EBV, a heterophile antibody test can detect immunoglobulin M (IgM) antibodies targeting EBV. False positive results may occur due to the cross-reactivity of IgM with other viral infections, hematological malignancies, and autoimmune disorders.<a class="bk_pop" href="#article-145596.r38">[38]</a> Despite these caveats, utilizing heterophile antibody testing as an initial approach is advantageous due to the affordability, rapidity, and sensitivity range of 63% to 84% and specificity range of 84% to 100%.<a class="bk_pop" href="#article-145596.r39">[39]</a> </p><p>Given the challenges of using serological markers to diagnose EBV infection, polymerase chain reaction (PCR) methods have been demonstrated to accurately detect primary EBV infection and reactivation in sera without heterophile antibodies.<a class="bk_pop" href="#article-145596.r38">[38]</a> Sensitivity and specificity among pediatric populations with infectious mononucleosis were 77% (95% CI 66-86%) and specificity 98% (95% CI 93-100%) respectively.<a class="bk_pop" href="#article-145596.r40">[40]</a> Furthermore, PCR may be applied to paraffin-embedded tissues with assay sensitivities as low as 50 copies of EBV DNA per reaction.<a class="bk_pop" href="#article-145596.r41">[41]</a> PCR has replaced culture as the primary means of detecting EBV in tissue.<a class="bk_pop" href="#article-145596.r42">[42]</a></p><p>Myopericarditis can result in elevated levels of inflammatory markers, including erythrocyte sedimentation rate, C-reactive protein, white blood cells, and cardiac biomarkers.<a class="bk_pop" href="#article-145596.r43">[43]</a> A comprehensive blood analysis is recommended for all patients to rule out thyroid disorders and hepatitis and assess renal function. This approach thoroughly evaluates the patient's overall health and contributing factors.<a class="bk_pop" href="#article-145596.r44">[44]</a> </p><p>
|
||
<b>Electrocardiogram</b>
|
||
</p><p>Characteristic electrocardiogram patterns in pericarditis encompass a widespread, concave elevation of ST segments and PR depression. These alterations, generalized T-wave modifications, or inversions can vary depending on the extent of myocardial engagement. While ST-segment alterations are generally diffuse, localized ECG shifts (inferolateral or anterolateral) can also manifest contingent on the degree of involvement. Frequent arrhythmias involve supraventricular or ventricular ectopic beats and brief episodes of ventricular arrhythmias.<a class="bk_pop" href="#article-145596.r45">[45]</a><a class="bk_pop" href="#article-145596.r46">[46]</a></p><p>
|
||
<b>Chest Radiography</b>
|
||
</p><p>Pericardial effusion may manifest as a rounded cardiac silhouette on a chest X-ray. Echocardiography typically confirms effusion, constriction, or tamponade.<a class="bk_pop" href="#article-145596.r47">[47]</a></p><p>
|
||
<b>Echocardiogram</b>
|
||
</p><p>The echocardiographic characteristics of myocarditis are non-specific. However, as a part of the routine evaluation, an echocardiogram is ordered, which may reveal normal heart function along with a minimal or absent pericardial effusion. The echocardiographic presentation can resemble various patterns, including dilated, hypertrophic, restrictive, or right ventricular cardiomyopathy, along with manifestations similar to coronary artery disease. Additionally, the echocardiogram assesses the functioning of both the left and right ventricles and identifies any abnormalities related to valvular heart disease.<a class="bk_pop" href="#article-145596.r48">[48]</a></p><p>
|
||
<b>Coronary Angiography</b>
|
||
</p><p>When there is suspicion of acute coronary syndrome, and the clinical presentation is reminiscent of coronary artery disease, this diagnostic approach is considered the definitive method to exclude its presence. In cases where traditional contraindications are not applicable, CT coronary angiography (CTCA) might be an alternative. For young patients exhibiting typical myopericarditis symptoms, coronary angiography is typically unnecessary. However, for individuals with risk factors associated with atherosclerotic cardiovascular disease, distinguishing between myopericarditis and myocardial ischemia through non-invasive testing is challenging. In such instances, cardiac catheterization is required to rule out acute coronary syndrome.<a class="bk_pop" href="#article-145596.r49">[49]</a><a class="bk_pop" href="#article-145596.r44">[44]</a></p><p>
|
||
<b>Cardiac Magnetic Resonance Imaging</b>
|
||
</p><p>Cardiac MRI is a promising technique for assessing individuals suspected of having myocarditis. The revised Lake Louis criteria now encompass T1 and T2 criteria for diagnosing myocarditis. T1 imaging reveals an elevated T1 relaxation time, while T2 imaging demonstrates an increased T2 relaxation time or Signal Intensity (SI). In addition, gadolinium-enhanced CMR sequences unveil irregular hyperenhancement patterns within the myocardial tissue.<a class="bk_pop" href="#article-145596.r50">[50]</a> Such changes are associated with a higher rate of mortality, including sudden cardiac death.<a class="bk_pop" href="#article-145596.r51">[51]</a></p><p>
|
||
<b>Endomyocardial Biopsy</b>
|
||
</p><p>Endomyocardial biopsy (EMB) is warranted in select cases of severely ill patients who demonstrate clinical deterioration after standard supportive treatment. EMB is the gold standard for diagnosis. According to the consensus scientific statement of the European Society of Cardiology, the American Heart Association, and the American College of Cardiology, a class I indication for performing EMB in myocarditis is in cases of new-onset heart failure lasting less than 2 weeks, involving preserved ventricle dimensions but compromised hemodynamics.<a class="bk_pop" href="#article-145596.r52">[52]</a> Additionally, EMB is indicated as a class I procedure for patients experiencing new-onset heart failure lasting 2 weeks to 3 months, characterized by dilated ventricles, tachyarrhythmia or bradyarrhythmia, and a lack of response to therapy within 1 to 2 weeks.<a class="bk_pop" href="#article-145596.r53">[53]</a></p></div><div id="article-145596.s9"><h2 id="_article-145596_s9_">Treatment / Management</h2><p>For the majority of patients, the overall prognosis of this condition is favorable, and long-term complications are rare. The available data to inform the management of myopericarditis are currently limited.<a class="bk_pop" href="#article-145596.r54">[54]</a> Viral myopericarditis is mainly supportive and follows the general management of myopericarditis. </p><p>
|
||
<b>Hemodynamically Unstable Patients</b>
|
||
</p><p>Patients presenting with a life-threatening condition should be directed to specialized facilities equipped with the capacity for hemodynamic monitoring, cardiac catheterization, expertise in EMB, and cardiac surgery. In instances of hemodynamic instability, the implementation of a mechanical cardio-pulmonary assist device is necessary to bridge either recovery or heart transplantation.<a class="bk_pop" href="#article-145596.r55">[55]</a> The consideration for cardiac transplantation should be postponed during the acute phase, as there is a potential for spontaneous recovery. However, this option is considered for hemodynamically unstable myocarditis patients, including those with giant cell myocarditis, if optimal pharmacological support and mechanical assistance fail to stabilize the patient.<a class="bk_pop" href="#article-145596.r56">[56]</a></p><p>
|
||
<b>Hemodynamically Stable Patients </b>
|
||
</p><p>For patients experiencing stable heart failure, the recommended treatment includes diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-adrenergic blockers. If individuals continue to show symptoms of heart failure despite receiving optimal care, one should consider adding aldosterone antagonists.<a class="bk_pop" href="#article-145596.r57">[57]</a> </p><p>When the initial manifestation resembles pericarditis symptoms, and the left ventricular function remains intact, the first-line treatment involves Nonsteroidal anti-inflammatory drugs (NSAIDs). However, in cases where substantial myocardial involvement is evident, NSAIDs are approached cautiously due to their potential to exacerbate myocardial function and cardiac failure.<a class="bk_pop" href="#article-145596.r58">[58]</a> In such instances, NSAIDs are administered at minimal dosages to avoid compromising myocardial health.<a class="bk_pop" href="#article-145596.r44">[44]</a></p><p>
|
||
<b>Arrhythmia</b>
|
||
</p><p>Ventricular or atrial arrhythmias and heart block are potential complications of acute myocarditis. In hemodynamically stable tachyarrhythmia without signs of peripheral hypoperfusion, β-blocker therapy is advised. Patients with sustained ventricular arrhythmias are recommended amiodarone and dofetilide as suitable treatment options. When necessary, heart block is addressed by implementing a temporary pacemaker followed by a permanent pacemaker. As the acute phase subsides, standard recommendations include an implantable cardioverter defibrillator during the chronic stage.<a class="bk_pop" href="#article-145596.r49">[49]</a></p><p>
|
||
<b>Avoidance of Exercise</b> </p><p>During acute myocarditis, physical activity should be restricted. Patients are discouraged from engaging in competitive sports for at least 3 to 6 months following the acute episode. Subsequent guidance hinges on regular follow-up involving clinical evaluation, echocardiography, and Holter monitoring.<a class="bk_pop" href="#article-145596.r59">[59]</a><a class="bk_pop" href="#article-145596.r60">[60]</a></p><p>
|
||
<b>Immunomodulatory Therapy</b>
|
||
</p><p>There is no approved antiviral therapy, but vaccination is a future possibility.<a class="bk_pop" href="#article-145596.r61">[61]</a></p><p>In cases of myocarditis that do not respond to standard heart failure treatments, including both viral and autoimmune types, especially those driven by autoantibodies, intravenous immunoglobulin (IVIG) may be employed to minimize adverse effects.<a class="bk_pop" href="#article-145596.r62">[62]</a></p><p>
|
||
<b>Immunosuppressive Therapy</b>
|
||
</p><p>The safety and effectiveness of immunosuppressive regimens for myocarditis are studied using steroids alone, combined with azathioprine or cyclosporine A, azathioprine, and steroids. Limited information is available regarding the use of other medications. Reports on treatment outcomes primarily focus on chronic cases that are negative for viral involvement.<a class="bk_pop" href="#article-145596.r56">[56]</a></p></div><div id="article-145596.s10"><h2 id="_article-145596_s10_">Differential Diagnosis</h2><p>
|
||
<b>Acute Coronary Syndrome</b> </p><p>Cardiovascular magnetic resonance imaging is vital in distinguishing between different causes of acute coronary syndromes. This significance is pronounced due to the vague and overlapping signs and symptoms, which resemble those of other conditions like myopericarditis.<a class="bk_pop" href="#article-145596.r63">[63]</a> The viral prodrome of EBV-associated myocarditis rules out acute coronary syndrome.</p><p>
|
||
<b>Chagas Heart Disease (CHD)</b>
|
||
</p><p>As a result of the protozoan parasite Trypanosoma cruzi, CHD is the primary cause of known infectious myocarditis globally, albeit concentrated within the Americas.<a class="bk_pop" href="#article-145596.r64">[64]</a> CHD comprises 2 distinct clinical phases: the acute phase, which emerges shortly following infection and persists for 4 to 8 weeks, and the chronic phase, which evolves over 10 to 30 years. The PCR is the most sensitive diagnostic tool in the acute phase of Chagas disease.<a class="bk_pop" href="#article-145596.r65">[65]</a> In around one-third of cases, the chronic phase develops from asymptomatic to symptomatic.</p><p>
|
||
<b>Cardiac Tamponade</b>
|
||
</p><p>Pericarditis frequently involves pericardial effusion, which could progress to cardiac tamponade.<a class="bk_pop" href="#article-145596.r66">[66]</a> Cardiac tamponade is a condition that arises when there is a sudden and excessive buildup of fluid within the pericardial cavity. </p></div><div id="article-145596.s11"><h2 id="_article-145596_s11_">Prognosis</h2><p>Differentiating acute myopericarditis from pericarditis is essential. Common viruses, including parvovirus B19, adenovirus, herpes viruses, hepatitis viruses, human immunodeficiency virus, and enteroviruses, can induce heart inflammation, leading to acute pericarditis and myocarditis.<a class="bk_pop" href="#article-145596.r67">[67]</a> EBV rarely contributes to these conditions in individuals with intact immune systems.<a class="bk_pop" href="#article-145596.r13">[13]</a> The prognosis can be jeopardized by heart failure, particularly in cases of severe onset. Due to the diverse clinical manifestations of EBV, the severity of such manifestations, and the interplay with host immune factors, the prognosis of EBV-related myopericarditis can vary. In general, patients experiencing acute decompensated heart failure, persistent arrhythmias, and a left ventricular ejection fraction below 50%, or those necessitating inotropic agents, vasopressors, or mechanical cardiac assistance, are more likely to encounter unfavorable cardiovascular outcomes.<a class="bk_pop" href="#article-145596.r68">[68]</a><a class="bk_pop" href="#article-145596.r69">[69]</a></p></div><div id="article-145596.s12"><h2 id="_article-145596_s12_">Complications</h2><p>Complications may vary according to the interplay between EBV and the host immune system, but known sequelae of viral (including EBV) related cardiac manifestations include:</p><ul><li class="half_rhythm"><div>Coronary artery dilatation<a class="bk_pop" href="#article-145596.r70">[70]</a></div></li><li class="half_rhythm"><div>Coronary artery aneurysm<a class="bk_pop" href="#article-145596.r71">[71]</a></div></li><li class="half_rhythm"><div>Valvular heart disease<a class="bk_pop" href="#article-145596.r72">[72]</a></div></li><li class="half_rhythm"><div>Acute myocardial infarction<a class="bk_pop" href="#article-145596.r21">[21]</a></div></li><li class="half_rhythm"><div>Pulmonary arterial hypertension<a class="bk_pop" href="#article-145596.r73">[73]</a></div></li><li class="half_rhythm"><div>Left ventricle dysfunction<a class="bk_pop" href="#article-145596.r24">[24]</a></div></li><li class="half_rhythm"><div>Right ventricle failure<a class="bk_pop" href="#article-145596.r74">[74]</a></div></li><li class="half_rhythm"><div>Arrhythmia<a class="bk_pop" href="#article-145596.r33">[33]</a></div></li><li class="half_rhythm"><div>Death secondary to the above</div></li></ul></div><div id="article-145596.s13"><h2 id="_article-145596_s13_">Deterrence and Patient Education</h2><p>Patients with EBV infection should be informed about potential complications, which range from asymptomatic conditions to life-threatening outcomes such as coronary artery dilation, valvular heart disease, and heart failure.<a class="bk_pop" href="#article-145596.r6">[6]</a> However, these fatal complications can be prevented with prompt and appropriate management. Transmission of EBV occurs primarily through close contact with infected individuals, mainly saliva.<a class="bk_pop" href="#article-145596.r2">[2]</a> Regular precautions that include awareness and personal hygiene prevent viral transmission. </p><p>Patients who develop myopericarditis and are hemodynamically unstable must have a timely referral to a highly specialized cardiac center. Other patients should receive symptomatic management following the principles of heart failure treatment. Patients with heart failure are more susceptible to unfavorable cardiac complications, so close monitoring and proper medical care are crucial. Timely and thorough cardiac evaluation is paramount to detecting potential complications and providing appropriate interventions. </p><p>In summary, educating patients about the potential complications of EBV infection, emphasizing the importance of transmission prevention, ensuring timely referrals for severe cases, and implementing appropriate management strategies can contribute to better outcomes and a reduced risk of complications.</p></div><div id="article-145596.s14"><h2 id="_article-145596_s14_">Enhancing Healthcare Team Outcomes </h2><p>Patients with EBV-associated myocarditis face a significant risk of mortality when not promptly and effectively treated. Therefore, early management is crucial for reducing morbidity and mortality. The care of individuals with EBV-associated myocarditis demands a collaborative approach involving healthcare professionals to provide patient-centered care and enhance overall outcomes.</p><p>A multidisciplinary team, including cardiologists, emergency medicine clinicians, critical care clinicians, advanced practitioners, nurses, pharmacists, physiotherapists, and other healthcare providers, should possess the clinical skills and knowledge to diagnose and manage EBV-associated myocarditis. The condition involves expertise in recognizing diverse clinical presentations and proficiency in diagnostic techniques such as echocardiography, cardiac MRI, and endomyocardial biopsy.<a class="bk_pop" href="#article-145596.r75">[75]</a><a class="bk_pop" href="#article-145596.r76">[76]</a> Furthermore, educating patients and caregivers about the condition's origins, symptoms, and utilization of diagnostic tools is vital in preventing cardiac complications and reducing morbidity.</p><p>A strategic approach involving evidence-based strategies to optimize treatment plans while minimizing adverse effects is crucial. Ethical considerations should steer decision-making, ensuring that informed consent is secured and patient autonomy is honored in the decision-making process. Every healthcare professional should be conscious of their responsibilities and contribute unique expertise to the patient's care plan, fostering a multidisciplinary approach.</p><p>Effective interprofessional communication is paramount, allowing for seamless information exchange and collaborative decision-making among team members. Care coordination is vital in ensuring that the patient's path from diagnosis to treatment and follow-up is effectively managed, minimizing errors and improving patient safety. By embracing these principles of skill, strategy, ethics, responsibilities, interprofessional communication, and care coordination, healthcare professionals can deliver integrated patient-centered care.</p></div><div id="article-145596.s15"><h2 id="_article-145596_s15_">Review Questions</h2><ul><li class="half_rhythm"><div>
|
||
<a href="https://www.statpearls.com/account/trialuserreg/?articleid=145596&utm_source=pubmed&utm_campaign=reviews&utm_content=145596" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
|
||
</div></li><li class="half_rhythm"><div>
|
||
<a href="https://mdsearchlight.com/infectious-disease/ebv-associated-myopericarditis/?utm_source=pubmedlink&utm_campaign=MDS&utm_content=145596" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Click here for a simplified version.</a>
|
||
</div></li><li class="half_rhythm"><div>
|
||
<a href="https://www.statpearls.com/articlelibrary/commentarticle/145596/?utm_source=pubmed&utm_campaign=comments&utm_content=145596" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Comment on this article.</a>
|
||
</div></li></ul></div><div id="article-145596.s16"><h2 id="_article-145596_s16_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="article-145596.r1">Zhang N, Zuo Y, Jiang L, Peng Y, Huang X, Zuo L. Epstein-Barr Virus and Neurological Diseases. <span><span class="ref-journal">Front Mol Biosci. </span>2021;<span class="ref-vol">8</span>:816098.</span> [<a href="/pmc/articles/PMC8784775/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8784775</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35083281" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35083281</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="article-145596.r2">Castillo A, Giraldo S, Guzmán N, Bravo LE. Factors associated with the presence of the Epstein-Barr virus in the oral cavity of high school students from the city of Cali (Colombia). <span><span class="ref-journal">Enferm Infecc Microbiol Clin (Engl Ed). </span>2022 Mar;<span class="ref-vol">40</span>(3):113-120.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/35000871" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35000871</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="article-145596.r3">Dunmire SK, Verghese PS, Balfour HH. Primary Epstein-Barr virus infection. <span><span class="ref-journal">J Clin Virol. </span>2018 May;<span class="ref-vol">102</span>:84-92.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29525635" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29525635</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="article-145596.r4">Nowalk A, Green M. Epstein-Barr Virus. <span><span class="ref-journal">Microbiol Spectr. </span>2016 Jun;<span class="ref-vol">4</span>(3)</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27337443" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27337443</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="article-145596.r5">Houen G, Trier NH. Epstein-Barr Virus and Systemic Autoimmune Diseases. <span><span class="ref-journal">Front Immunol. </span>2020;<span class="ref-vol">11</span>:587380.</span> [<a href="/pmc/articles/PMC7817975/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7817975</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33488588" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33488588</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="article-145596.r6">Muneuchi J, Ohga S, Ishimura M, Ikeda K, Yamaguchi K, Nomura A, Takada H, Abe Y, Hara T. Cardiovascular complications associated with chronic active Epstein-Barr virus infection. <span><span class="ref-journal">Pediatr Cardiol. </span>2009 Apr;<span class="ref-vol">30</span>(3):274-81.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19184184" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19184184</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="article-145596.r7">Chen X, Li Y, Deng L, Wang L, Zhong W, Hong J, Chen L, Yang J, Huang B, Xiao X. Cardiovascular involvement in Epstein-Barr virus infection. <span><span class="ref-journal">Front Immunol. </span>2023;<span class="ref-vol">14</span>:1188330.</span> [<a href="/pmc/articles/PMC10246501/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10246501</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37292213" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37292213</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="article-145596.r8">Odumade OA, Hogquist KA, Balfour HH. Progress and problems in understanding and managing primary Epstein-Barr virus infections. <span><span class="ref-journal">Clin Microbiol Rev. </span>2011 Jan;<span class="ref-vol">24</span>(1):193-209.</span> [<a href="/pmc/articles/PMC3021204/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3021204</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21233512" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21233512</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="article-145596.r9">Sarwari NM, Khoury JD, Hernandez CM. Chronic Epstein Barr virus infection leading to classical Hodgkin lymphoma. <span><span class="ref-journal">BMC Hematol. </span>2016;<span class="ref-vol">16</span>:19.</span> [<a href="/pmc/articles/PMC4950766/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4950766</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27437106" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27437106</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="article-145596.r10">Michelow P, Wright C, Pantanowitz L. A review of the cytomorphology of Epstein-Barr virus-associated malignancies. <span><span class="ref-journal">Acta Cytol. </span>2012;<span class="ref-vol">56</span>(1):1-14.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22236740" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22236740</span></a>]</div></dd><dt>11.</dt><dd><div class="bk_ref" id="article-145596.r11">Henle G, Henle W, Diehl V. Relation of Burkitt's tumor-associated herpes-ytpe virus to infectious mononucleosis. <span><span class="ref-journal">Proc Natl Acad Sci U S A. </span>1968 Jan;<span class="ref-vol">59</span>(1):94-101.</span> [<a href="/pmc/articles/PMC286007/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC286007</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/5242134" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 5242134</span></a>]</div></dd><dt>12.</dt><dd><div class="bk_ref" id="article-145596.r12">Nguyen ADK, Siu R, Kleinschmidt G, Sood BP, Shandiz EE. Epstein-Barr virus reactivation-related meningoencephalitis with transverse myelitis in pregnancy. <span><span class="ref-journal">Clin Case Rep. </span>2023 Sep;<span class="ref-vol">11</span>(9):e7923.</span> [<a href="/pmc/articles/PMC10514378/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10514378</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37744622" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37744622</span></a>]</div></dd><dt>13.</dt><dd><div class="bk_ref" id="article-145596.r13">Sausen DG, Bhutta MS, Gallo ES, Dahari H, Borenstein R. Stress-Induced Epstein-Barr Virus Reactivation. <span><span class="ref-journal">Biomolecules. </span>2021 Sep 18;<span class="ref-vol">11</span>(9)</span> [<a href="/pmc/articles/PMC8470332/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8470332</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34572593" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34572593</span></a>]</div></dd><dt>14.</dt><dd><div class="bk_ref" id="article-145596.r14">Henle W. Evidence for viruses in acute leukemia and Burkitt's tumor. <span><span class="ref-journal">Cancer. </span>1968 Apr;<span class="ref-vol">21</span>(4):580-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/4868472" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4868472</span></a>]</div></dd><dt>15.</dt><dd><div class="bk_ref" id="article-145596.r15">Cohen JI. Epstein-Barr virus infection. <span><span class="ref-journal">N Engl J Med. </span>2000 Aug 17;<span class="ref-vol">343</span>(7):481-92.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10944566" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10944566</span></a>]</div></dd><dt>16.</dt><dd><div class="bk_ref" id="article-145596.r16">Dowd JB, Palermo T, Brite J, McDade TW, Aiello A. Seroprevalence of Epstein-Barr virus infection in U.S. children ages 6-19, 2003-2010. <span><span class="ref-journal">PLoS One. </span>2013;<span class="ref-vol">8</span>(5):e64921.</span> [<a href="/pmc/articles/PMC3661547/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3661547</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23717674" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23717674</span></a>]</div></dd><dt>17.</dt><dd><div class="bk_ref" id="article-145596.r17">Sharifipour S, Davoodi Rad K. Seroprevalence of Epstein-Barr virus among children and adults in Tehran, Iran. <span><span class="ref-journal">New Microbes New Infect. </span>2020 Mar;<span class="ref-vol">34</span>:100641.</span> [<a href="/pmc/articles/PMC6997212/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6997212</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32025310" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32025310</span></a>]</div></dd><dt>18.</dt><dd><div class="bk_ref" id="article-145596.r18">Kuri A, Jacobs BM, Vickaryous N, Pakpoor J, Middeldorp J, Giovannoni G, Dobson R. Epidemiology of Epstein-Barr virus infection and infectious mononucleosis in the United Kingdom. <span><span class="ref-journal">BMC Public Health. </span>2020 Jun 12;<span class="ref-vol">20</span>(1):912.</span> [<a href="/pmc/articles/PMC7291753/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7291753</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32532296" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32532296</span></a>]</div></dd><dt>19.</dt><dd><div class="bk_ref" id="article-145596.r19">Gares V, Panico L, Castagne R, Delpierre C, Kelly-Irving M. The role of the early social environment on Epstein Barr virus infection: a prospective observational design using the Millennium Cohort Study. <span><span class="ref-journal">Epidemiol Infect. </span>2017 Dec;<span class="ref-vol">145</span>(16):3405-3412.</span> [<a href="/pmc/articles/PMC9148726/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9148726</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29202893" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29202893</span></a>]</div></dd><dt>20.</dt><dd><div class="bk_ref" id="article-145596.r20">Ace O, Domb S. Myocarditis as the initial presentation of Epstein-Barr virus infection in a 17-year-old male patient. <span><span class="ref-journal">Can Fam Physician. </span>2019 Dec;<span class="ref-vol">65</span>(12):897-899.</span> [<a href="/pmc/articles/PMC6907365/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6907365</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31831489" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31831489</span></a>]</div></dd><dt>21.</dt><dd><div class="bk_ref" id="article-145596.r21">Binkley PF, Cooke GE, Lesinski A, Taylor M, Chen M, Laskowski B, Waldman WJ, Ariza ME, Williams MV, Knight DA, Glaser R. Evidence for the role of Epstein Barr Virus infections in the pathogenesis of acute coronary events. <span><span class="ref-journal">PLoS One. </span>2013;<span class="ref-vol">8</span>(1):e54008.</span> [<a href="/pmc/articles/PMC3547968/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3547968</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23349778" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23349778</span></a>]</div></dd><dt>22.</dt><dd><div class="bk_ref" id="article-145596.r22">Chimenti C, Russo A, Pieroni M, Calabrese F, Verardo R, Thiene G, Russo MA, Maseri A, Frustaci A. Intramyocyte detection of Epstein-Barr virus genome by laser capture microdissection in patients with inflammatory cardiomyopathy. <span><span class="ref-journal">Circulation. </span>2004 Dec 07;<span class="ref-vol">110</span>(23):3534-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15557377" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15557377</span></a>]</div></dd><dt>23.</dt><dd><div class="bk_ref" id="article-145596.r23">Sole MJ, Liu P. Viral myocarditis: a paradigm for understanding the pathogenesis and treatment of dilated cardiomyopathy. <span><span class="ref-journal">J Am Coll Cardiol. </span>1993 Oct;<span class="ref-vol">22</span>(4 Suppl A):99A-105A.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8376702" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8376702</span></a>]</div></dd><dt>24.</dt><dd><div class="bk_ref" id="article-145596.r24">Sozzi FB, Gherbesi E, Faggiano A, Gnan E, Maruccio A, Schiavone M, Iacuzio L, Carugo S. Viral Myocarditis: Classification, Diagnosis, and Clinical Implications. <span><span class="ref-journal">Front Cardiovasc Med. </span>2022;<span class="ref-vol">9</span>:908663.</span> [<a href="/pmc/articles/PMC9250986/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9250986</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35795363" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35795363</span></a>]</div></dd><dt>25.</dt><dd><div class="bk_ref" id="article-145596.r25">Aretz HT, Billingham ME, Edwards WD, Factor SM, Fallon JT, Fenoglio JJ, Olsen EG, Schoen FJ. Myocarditis. A histopathologic definition and classification. <span><span class="ref-journal">Am J Cardiovasc Pathol. </span>1987 Jan;<span class="ref-vol">1</span>(1):3-14.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3455232" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3455232</span></a>]</div></dd><dt>26.</dt><dd><div class="bk_ref" id="article-145596.r26">Cooper LT. Myocarditis. <span><span class="ref-journal">N Engl J Med. </span>2009 Apr 09;<span class="ref-vol">360</span>(15):1526-38.</span> [<a href="/pmc/articles/PMC5814110/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5814110</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19357408" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19357408</span></a>]</div></dd><dt>27.</dt><dd><div class="bk_ref" id="article-145596.r27">ElAmm CA, Al-Kindi SG, Oliveira GH. Characteristics and Outcomes of Patients With Myocarditis Listed for Heart Transplantation. <span><span class="ref-journal">Circ Heart Fail. </span>2016 Dec;<span class="ref-vol">9</span>(12)</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27927755" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27927755</span></a>]</div></dd><dt>28.</dt><dd><div class="bk_ref" id="article-145596.r28">Sharif N, Dehghani P. Emergency files: acute pericarditis, myocarditis, and worse! <span><span class="ref-journal">Can Fam Physician. </span>2013 Jan;<span class="ref-vol">59</span>(1):39-41.</span> [<a href="/pmc/articles/PMC3555652/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3555652</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23341656" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23341656</span></a>]</div></dd><dt>29.</dt><dd><div class="bk_ref" id="article-145596.r29">Olejniczak M, Schwartz M, Webber E, Shaffer A, Perry TE. Viral Myocarditis-Incidence, Diagnosis and Management. <span><span class="ref-journal">J Cardiothorac Vasc Anesth. </span>2020 Jun;<span class="ref-vol">34</span>(6):1591-1601.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32127272" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32127272</span></a>]</div></dd><dt>30.</dt><dd><div class="bk_ref" id="article-145596.r30">Roubille F, Gahide G, Moore-Morris T, Granier M, Davy JM, Vernhet H, Piot C. Epstein Barr virus (EBV) and acute myopericarditis in an immunocompetent patient: first demonstrated case and discussion. <span><span class="ref-journal">Intern Med. </span>2008;<span class="ref-vol">47</span>(7):627-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/18379149" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18379149</span></a>]</div></dd><dt>31.</dt><dd><div class="bk_ref" id="article-145596.r31">Fung RCM, Hon KL, Leung AKC. Acute Myocarditis in Children: An Overview of Treatment and Recent Patents. <span><span class="ref-journal">Recent Pat Inflamm Allergy Drug Discov. </span>2020;<span class="ref-vol">14</span>(2):106-116.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32013855" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32013855</span></a>]</div></dd><dt>32.</dt><dd><div class="bk_ref" id="article-145596.r32">Dec GW, Waldman H, Southern J, Fallon JT, Hutter AM, Palacios I. Viral myocarditis mimicking acute myocardial infarction. <span><span class="ref-journal">J Am Coll Cardiol. </span>1992 Jul;<span class="ref-vol">20</span>(1):85-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1607543" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1607543</span></a>]</div></dd><dt>33.</dt><dd><div class="bk_ref" id="article-145596.r33">Harris KM, Mackey-Bojack S, Bennett M, Nwaudo D, Duncanson E, Maron BJ. Sudden Unexpected Death Due to Myocarditis in Young People, Including Athletes. <span><span class="ref-journal">Am J Cardiol. </span>2021 Mar 15;<span class="ref-vol">143</span>:131-134.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33347841" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33347841</span></a>]</div></dd><dt>34.</dt><dd><div class="bk_ref" id="article-145596.r34">Schultz JC, Hilliard AA, Cooper LT, Rihal CS. Diagnosis and treatment of viral myocarditis. <span><span class="ref-journal">Mayo Clin Proc. </span>2009 Nov;<span class="ref-vol">84</span>(11):1001-9.</span> [<a href="/pmc/articles/PMC2770911/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2770911</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19880690" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19880690</span></a>]</div></dd><dt>35.</dt><dd><div class="bk_ref" id="article-145596.r35">Ammirati E, Moslehi JJ. Diagnosis and Treatment of Acute Myocarditis: A Review. <span><span class="ref-journal">JAMA. </span>2023 Apr 04;<span class="ref-vol">329</span>(13):1098-1113.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/37014337" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37014337</span></a>]</div></dd><dt>36.</dt><dd><div class="bk_ref" id="article-145596.r36">Kyaw T, Drummond G, Bobik A, Peter K. Myocarditis: causes, mechanisms, and evolving therapies. <span><span class="ref-journal">Expert Opin Ther Targets. </span>2023 Mar;<span class="ref-vol">27</span>(3):225-238.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/36946552" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36946552</span></a>]</div></dd><dt>37.</dt><dd><div class="bk_ref" id="article-145596.r37">Adegbala O, Olagoke O, Akintoye E, Adejumo AC, Oluwole A, Jara C, Williams K, Briasoulis A, Afonso L. Predictors, Burden, and the Impact of Arrhythmia on Patients Admitted for Acute Myocarditis. <span><span class="ref-journal">Am J Cardiol. </span>2019 Jan 01;<span class="ref-vol">123</span>(1):139-144.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30539745" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30539745</span></a>]</div></dd><dt>38.</dt><dd><div class="bk_ref" id="article-145596.r38">Marshall-Andon T, Heinz P. How to use … the Monospot and other heterophile antibody tests. <span><span class="ref-journal">Arch Dis Child Educ Pract Ed. </span>2017 Aug;<span class="ref-vol">102</span>(4):188-193.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28130396" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28130396</span></a>]</div></dd><dt>39.</dt><dd><div class="bk_ref" id="article-145596.r39">Womack J, Jimenez M. Common questions about infectious mononucleosis. <span><span class="ref-journal">Am Fam Physician. </span>2015 Mar 15;<span class="ref-vol">91</span>(6):372-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25822555" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25822555</span></a>]</div></dd><dt>40.</dt><dd><div class="bk_ref" id="article-145596.r40">Jiang SY, Yang JW, Shao JB, Liao XL, Lu ZH, Jiang H. Real-time polymerase chain reaction for diagnosing infectious mononucleosis in pediatric patients: A systematic review and meta-analysis. <span><span class="ref-journal">J Med Virol. </span>2016 May;<span class="ref-vol">88</span>(5):871-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26455510" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26455510</span></a>]</div></dd><dt>41.</dt><dd><div class="bk_ref" id="article-145596.r41">Ryan JL, Fan H, Glaser SL, Schichman SA, Raab-Traub N, Gulley ML. Epstein-Barr virus quantitation by real-time PCR targeting multiple gene segments: a novel approach to screen for the virus in paraffin-embedded tissue and plasma. <span><span class="ref-journal">J Mol Diagn. </span>2004 Nov;<span class="ref-vol">6</span>(4):378-85.</span> [<a href="/pmc/articles/PMC1867486/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1867486</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/15507678" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15507678</span></a>]</div></dd><dt>42.</dt><dd><div class="bk_ref" id="article-145596.r42">Haque T, Crawford DH. PCR amplification is more sensitive than tissue culture methods for Epstein-Barr virus detection in clinical material. <span><span class="ref-journal">J Gen Virol. </span>1997 Dec;<span class="ref-vol">78 ( Pt 12)</span>:3357-60.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9400988" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9400988</span></a>]</div></dd><dt>43.</dt><dd><div class="bk_ref" id="article-145596.r43">Lampejo T, Durkin SM, Bhatt N, Guttmann O. Acute myocarditis: aetiology, diagnosis and management. <span><span class="ref-journal">Clin Med (Lond). </span>2021 Sep;<span class="ref-vol">21</span>(5):e505-e510.</span> [<a href="/pmc/articles/PMC8439515/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8439515</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34507935" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34507935</span></a>]</div></dd><dt>44.</dt><dd><div class="bk_ref" id="article-145596.r44">Manda YR, Baradhi KM. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jul 17, 2023. Myopericarditis. [<a href="https://pubmed.ncbi.nlm.nih.gov/30521197" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30521197</span></a>]</div></dd><dt>45.</dt><dd><div class="bk_ref" id="article-145596.r45">Marinella MA. Electrocardiographic manifestations and differential diagnosis of acute pericarditis. <span><span class="ref-journal">Am Fam Physician. </span>1998 Feb 15;<span class="ref-vol">57</span>(4):699-704.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9490993" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9490993</span></a>]</div></dd><dt>46.</dt><dd><div class="bk_ref" id="article-145596.r46">Watanabe M, Panetta GL, Piccirillo F, Spoto S, Myers J, Serino FM, Costantino S, Di Sciascio G. Acute Epstein-Barr related myocarditis: An unusual but life-threatening disease in an immunocompetent patient. <span><span class="ref-journal">J Cardiol Cases. </span>2020 Apr;<span class="ref-vol">21</span>(4):137-140.</span> [<a href="/pmc/articles/PMC7102541/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7102541</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32256861" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32256861</span></a>]</div></dd><dt>47.</dt><dd><div class="bk_ref" id="article-145596.r47">Rahman A, Liu D. Pericarditis - clinical features and management. <span><span class="ref-journal">Aust Fam Physician. </span>2011 Oct;<span class="ref-vol">40</span>(10):791-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22003482" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22003482</span></a>]</div></dd><dt>48.</dt><dd><div class="bk_ref" id="article-145596.r48">Pinamonti B, Alberti E, Cigalotto A, Dreas L, Salvi A, Silvestri F, Camerini F. Echocardiographic findings in myocarditis. <span><span class="ref-journal">Am J Cardiol. </span>1988 Aug 01;<span class="ref-vol">62</span>(4):285-91.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3400607" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3400607</span></a>]</div></dd><dt>49.</dt><dd><div class="bk_ref" id="article-145596.r49">Al-Akchar M, Shams P, Kiel J. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jul 5, 2023. Acute Myocarditis. [<a href="https://pubmed.ncbi.nlm.nih.gov/28722877" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28722877</span></a>]</div></dd><dt>50.</dt><dd><div class="bk_ref" id="article-145596.r50">Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, Carbone I, Sechtem U, Kindermann I, Gutberlet M, Cooper LT, Liu P, Friedrich MG. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. <span><span class="ref-journal">J Am Coll Cardiol. </span>2018 Dec 18;<span class="ref-vol">72</span>(24):3158-3176.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30545455" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30545455</span></a>]</div></dd><dt>51.</dt><dd><div class="bk_ref" id="article-145596.r51">Greulich S, Seitz A, Müller KAL, Grün S, Ong P, Ebadi N, Kreisselmeier KP, Seizer P, Bekeredjian R, Zwadlo C, Gräni C, Klingel K, Gawaz M, Sechtem U, Mahrholdt H. Predictors of Mortality in Patients With Biopsy-Proven Viral Myocarditis: 10-Year Outcome Data. <span><span class="ref-journal">J Am Heart Assoc. </span>2020 Aug 18;<span class="ref-vol">9</span>(16):e015351.</span> [<a href="/pmc/articles/PMC7660832/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7660832</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32787653" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32787653</span></a>]</div></dd><dt>52.</dt><dd><div class="bk_ref" id="article-145596.r52">Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, Levine GN, Narula J, Starling RC, Towbin J, Virmani R., American Heart Association. American College of Cardiology. European Society of Cardiology. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. <span><span class="ref-journal">Circulation. </span>2007 Nov 06;<span class="ref-vol">116</span>(19):2216-33.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17959655" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17959655</span></a>]</div></dd><dt>53.</dt><dd><div class="bk_ref" id="article-145596.r53">Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, Levine GN, Narula J, Starling RC, Towbin J, Virmani R., American Heart Association. American College of Cardiology. European Society of Cardiology. Heart Failure Society of America. Heart Failure Association of the European Society of Cardiology. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. <span><span class="ref-journal">J Am Coll Cardiol. </span>2007 Nov 06;<span class="ref-vol">50</span>(19):1914-31.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17980265" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17980265</span></a>]</div></dd><dt>54.</dt><dd><div class="bk_ref" id="article-145596.r54">Imazio M, Brucato A, Spodick DH, Adler Y. Prognosis of myopericarditis as determined from previously published reports. <span><span class="ref-journal">J Cardiovasc Med (Hagerstown). </span>2014 Dec;<span class="ref-vol">15</span>(12):835-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24850499" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24850499</span></a>]</div></dd><dt>55.</dt><dd><div class="bk_ref" id="article-145596.r55">Tschöpe C, Cooper LT, Torre-Amione G, Van Linthout S. Management of Myocarditis-Related Cardiomyopathy in Adults. <span><span class="ref-journal">Circ Res. </span>2019 May 24;<span class="ref-vol">124</span>(11):1568-1583.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31120823" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31120823</span></a>]</div></dd><dt>56.</dt><dd><div class="bk_ref" id="article-145596.r56">Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, Fu M, Heliö T, Heymans S, Jahns R, Klingel K, Linhart A, Maisch B, McKenna W, Mogensen J, Pinto YM, Ristic A, Schultheiss HP, Seggewiss H, Tavazzi L, Thiene G, Yilmaz A, Charron P, Elliott PM., European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. <span><span class="ref-journal">Eur Heart J. </span>2013 Sep;<span class="ref-vol">34</span>(33):2636-48, 2648a-2648d.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23824828" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23824828</span></a>]</div></dd><dt>57.</dt><dd><div class="bk_ref" id="article-145596.r57">McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Ronnevik K, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad Falez, Zeiher A., Avrupa Kardiyoloji Derneği (ESC) Akut ve Kronik Kalp Yetersizliği Tani ve Tedavisi 2012 Görev Grubu. ESC Kalp Yetersizliği Birliğinin Işbirliğiyle hazirlanmiştir. Heart Failure Association. [ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012]. <span><span class="ref-journal">Turk Kardiyol Dern Ars. </span>2012 Oct;<span class="ref-vol">40 Suppl 3</span>:77-137.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27305718" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27305718</span></a>]</div></dd><dt>58.</dt><dd><div class="bk_ref" id="article-145596.r58">Lampejo T. Caution with the use of NSAIDs in myocarditis. <span><span class="ref-journal">QJM. </span>2023 Feb 24;<span class="ref-vol">116</span>(2):153.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/35289907" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35289907</span></a>]</div></dd><dt>59.</dt><dd><div class="bk_ref" id="article-145596.r59">Patriki D, Baltensperger N, Berg J, Cooper LT, Kissel CK, Kottwitz J, Lovrinovic M, Manka R, Scherff F, Schmied C, Tanner FC, Luescher TF, Heidecker B. A Prospective Pilot Study to Identify a Myocarditis Cohort who may Safely Resume Sports Activities 3 Months after Diagnosis. <span><span class="ref-journal">J Cardiovasc Transl Res. </span>2021 Aug;<span class="ref-vol">14</span>(4):670-673.</span> [<a href="/pmc/articles/PMC8397673/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8397673</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32367345" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32367345</span></a>]</div></dd><dt>60.</dt><dd><div class="bk_ref" id="article-145596.r60">Maisch B, Alter P. Treatment options in myocarditis and inflammatory cardiomyopathy : Focus on i. v. immunoglobulins. <span><span class="ref-journal">Herz. </span>2018 Aug;<span class="ref-vol">43</span>(5):423-430.</span> [<a href="/pmc/articles/PMC6096625/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6096625</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29947834" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29947834</span></a>]</div></dd><dt>61.</dt><dd><div class="bk_ref" id="article-145596.r61">Martino TA, Liu P, Sole MJ. Viral infection and the pathogenesis of dilated cardiomyopathy. <span><span class="ref-journal">Circ Res. </span>1994 Feb;<span class="ref-vol">74</span>(2):182-8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8293557" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8293557</span></a>]</div></dd><dt>62.</dt><dd><div class="bk_ref" id="article-145596.r62">Kindermann I, Barth C, Mahfoud F, Ukena C, Lenski M, Yilmaz A, Klingel K, Kandolf R, Sechtem U, Cooper LT, Böhm M. Update on myocarditis. <span><span class="ref-journal">J Am Coll Cardiol. </span>2012 Feb 28;<span class="ref-vol">59</span>(9):779-92.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22361396" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22361396</span></a>]</div></dd><dt>63.</dt><dd><div class="bk_ref" id="article-145596.r63">Bolognesi M, Bolognesi D. Acute coronary syndrome <em>vs.</em> myopericarditis - not always a straightforward diagnosis. <span><span class="ref-journal">Am J Case Rep. </span>2013;<span class="ref-vol">14</span>:221-225.</span> [<a href="/pmc/articles/PMC3700493/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3700493</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23826474" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23826474</span></a>]</div></dd><dt>64.</dt><dd><div class="bk_ref" id="article-145596.r64">Pérez-Molina JA, Molina I. Chagas disease. <span><span class="ref-journal">Lancet. </span>2018 Jan 06;<span class="ref-vol">391</span>(10115):82-94.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28673423" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28673423</span></a>]</div></dd><dt>65.</dt><dd><div class="bk_ref" id="article-145596.r65">Bonney KM, Engman DM. Chagas heart disease pathogenesis: one mechanism or many? <span><span class="ref-journal">Curr Mol Med. </span>2008 Sep;<span class="ref-vol">8</span>(6):510-8.</span> [<a href="/pmc/articles/PMC2859714/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2859714</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18781958" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18781958</span></a>]</div></dd><dt>66.</dt><dd><div class="bk_ref" id="article-145596.r66">Sharma NK, Waymack JR. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jul 31, 2023. Acute Cardiac Tamponade. [<a href="https://pubmed.ncbi.nlm.nih.gov/30521227" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30521227</span></a>]</div></dd><dt>67.</dt><dd><div class="bk_ref" id="article-145596.r67">Andréoletti L, Lévêque N, Boulagnon C, Brasselet C, Fornes P. Viral causes of human myocarditis. <span><span class="ref-journal">Arch Cardiovasc Dis. </span>2009 Jun-Jul;<span class="ref-vol">102</span>(6-7):559-68.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19664576" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19664576</span></a>]</div></dd><dt>68.</dt><dd><div class="bk_ref" id="article-145596.r68">Ammirati E, Cipriani M, Moro C, Raineri C, Pini D, Sormani P, Mantovani R, Varrenti M, Pedrotti P, Conca C, Mafrici A, Grosu A, Briguglia D, Guglielmetto S, Perego GB, Colombo S, Caico SI, Giannattasio C, Maestroni A, Carubelli V, Metra M, Lombardi C, Campodonico J, Agostoni P, Peretto G, Scelsi L, Turco A, Di Tano G, Campana C, Belloni A, Morandi F, Mortara A, Cirò A, Senni M, Gavazzi A, Frigerio M, Oliva F, Camici PG., Registro Lombardo delle Miocarditi. Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis: Multicenter Lombardy Registry. <span><span class="ref-journal">Circulation. </span>2018 Sep 11;<span class="ref-vol">138</span>(11):1088-1099.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29764898" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29764898</span></a>]</div></dd><dt>69.</dt><dd><div class="bk_ref" id="article-145596.r69">Piccirillo F, Watanabe M, Di Sciascio G. Diagnosis, treatment and predictors of prognosis of myocarditis. A narrative review. <span><span class="ref-journal">Cardiovasc Pathol. </span>2021 Sep-Oct;<span class="ref-vol">54</span>:107362.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/34192559" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34192559</span></a>]</div></dd><dt>70.</dt><dd><div class="bk_ref" id="article-145596.r70">Rached-D'Astous S, Boukas I, Fournier A, Raboisson MJ, Dahdah N. Coronary Artery Dilatation in Viral Myocarditis Mimics Coronary Artery Findings in Kawasaki Disease. <span><span class="ref-journal">Pediatr Cardiol. </span>2016 Aug;<span class="ref-vol">37</span>(6):1148-52.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27233663" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27233663</span></a>]</div></dd><dt>71.</dt><dd><div class="bk_ref" id="article-145596.r71">Xiao H, Hu B, Luo R, Hu H, Zhang J, Kuang W, Zhang R, Li L, Liu G. Chronic active Epstein-Barr virus infection manifesting as coronary artery aneurysm and uveitis. <span><span class="ref-journal">Virol J. </span>2020 Oct 29;<span class="ref-vol">17</span>(1):166.</span> [<a href="/pmc/articles/PMC7597064/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7597064</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33121509" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33121509</span></a>]</div></dd><dt>72.</dt><dd><div class="bk_ref" id="article-145596.r72">Myers JM, Fairweather D, Huber SA, Cunningham MW. Autoimmune myocarditis, valvulitis, and cardiomyopathy. <span><span class="ref-journal">Curr Protoc Immunol. </span>2013;<span class="ref-vol">Chapter 15</span>:Unit 15.14.1-51.</span> [<a href="/pmc/articles/PMC3672855/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3672855</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23564686" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23564686</span></a>]</div></dd><dt>73.</dt><dd><div class="bk_ref" id="article-145596.r73">Fukuda Y, Momoi N, Akaihata M, Nagasawa K, Mitomo M, Aoyagi Y, Endoh K, Hosoya M. Pulmonary arterial hypertension associated with chronic active Epstein-Barr virus infection. <span><span class="ref-journal">Pediatr Int. </span>2015 Aug;<span class="ref-vol">57</span>(4):731-4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25809637" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25809637</span></a>]</div></dd><dt>74.</dt><dd><div class="bk_ref" id="article-145596.r74">Mancio J, Bettencourt N, Oliveira M, Pires-Morais G, Ribeiro VG. Acute right ventricular myocarditis presenting with chest pain and syncope. <span><span class="ref-journal">BMJ Case Rep. </span>2013 Oct 04;<span class="ref-vol">2013</span></span> [<a href="/pmc/articles/PMC3822266/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3822266</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24096068" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24096068</span></a>]</div></dd><dt>75.</dt><dd><div class="bk_ref" id="article-145596.r75">Kiamanesh O, Toma M. The State of the Heart Biopsy: A Clinical Review. <span><span class="ref-journal">CJC Open. </span>2021 Apr;<span class="ref-vol">3</span>(4):524-531.</span> [<a href="/pmc/articles/PMC8129478/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8129478</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34027357" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34027357</span></a>]</div></dd><dt>76.</dt><dd><div class="bk_ref" id="article-145596.r76">Altman RK, Parks KA, Schlett CL, Orencole M, Park MY, Truong QA, Deeprasertkul P, Moore SA, Barrett CD, Lewis GD, Das S, Upadhyay GA, Heist EK, Picard MH, Singh JP. Multidisciplinary care of patients receiving cardiac resynchronization therapy is associated with improved clinical outcomes. <span><span class="ref-journal">Eur Heart J. </span>2012 Sep;<span class="ref-vol">33</span>(17):2181-8.</span> [<a href="/pmc/articles/PMC3634395/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3634395</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22613342" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22613342</span></a>]</div></dd></dl></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin">
|
||
<b>Disclosure: </b>Rakesh Das declares no relevant financial relationships with ineligible companies.</p></div></dd><dt></dt><dd><div><p class="no_top_margin">
|
||
<b>Disclosure: </b>Andrew Nguyen declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></div></div></div>
|
||
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
|
||
This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
|
||
(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
|
||
http://creativecommons.org/licenses/by-nc-nd/4.0/
|
||
</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
|
||
</p></div><div class="small"><span class="label">Bookshelf ID: NBK599522</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/38261671" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">38261671</a></span></div></div></div>
|
||
|
||
</div>
|
||
|
||
<!-- Custom content below content -->
|
||
<div class="col4">
|
||
|
||
</div>
|
||
|
||
|
||
<!-- Book content -->
|
||
|
||
<!-- Custom contetnt below bottom nav -->
|
||
<div class="col5">
|
||
|
||
</div>
|
||
</div>
|
||
|
||
<div id="rightcolumn" class="four_col col last">
|
||
<!-- Custom content above discovery portlets -->
|
||
<div class="col6">
|
||
<div id="ncbi_share_book"><a href="#" class="ncbi_share" data-ncbi_share_config="popup:false,shorten:true" ref="id=NBK599522&db=books">Share</a></div>
|
||
|
||
</div>
|
||
<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK599522/?report=reader">PubReader</a></li><li><a href="/books/NBK599522/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK599522" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK599522" style="display:none" title="Cite this Page"><div class="bk_tt">Das R, Nguyen AD. EBV-Associated Myopericarditis. [Updated 2024 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. <span class="bk_cite_avail"></span></div></div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#article-145596.s1" ref="log$=inpage&link_id=inpage">Continuing Education Activity</a></li><li><a href="#article-145596.s2" ref="log$=inpage&link_id=inpage">Introduction</a></li><li><a href="#article-145596.s3" ref="log$=inpage&link_id=inpage">Etiology</a></li><li><a href="#article-145596.s4" ref="log$=inpage&link_id=inpage">Epidemiology</a></li><li><a href="#article-145596.s5" ref="log$=inpage&link_id=inpage">Pathophysiology</a></li><li><a href="#article-145596.s6" ref="log$=inpage&link_id=inpage">Histopathology</a></li><li><a href="#article-145596.s7" ref="log$=inpage&link_id=inpage">History and Physical</a></li><li><a href="#article-145596.s8" ref="log$=inpage&link_id=inpage">Evaluation</a></li><li><a href="#article-145596.s9" ref="log$=inpage&link_id=inpage">Treatment / Management</a></li><li><a href="#article-145596.s10" ref="log$=inpage&link_id=inpage">Differential Diagnosis</a></li><li><a href="#article-145596.s11" ref="log$=inpage&link_id=inpage">Prognosis</a></li><li><a href="#article-145596.s12" ref="log$=inpage&link_id=inpage">Complications</a></li><li><a href="#article-145596.s13" ref="log$=inpage&link_id=inpage">Deterrence and Patient Education</a></li><li><a href="#article-145596.s14" ref="log$=inpage&link_id=inpage">Enhancing Healthcare Team Outcomes </a></li><li><a href="#article-145596.s15" ref="log$=inpage&link_id=inpage">Review Questions</a></li><li><a href="#article-145596.s16" ref="log$=inpage&link_id=inpage">References</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Bulk Download</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://ftp.ncbi.nlm.nih.gov/pub/litarch/3d/12/" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">Bulk download StatPearls data from FTP</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related information</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="discovery_db_links" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pmc&DbFrom=books&Cmd=Link&LinkName=books_pmc_refs&IdsFromResult=5557100" ref="log$=recordlinks">PMC</a><div class="brieflinkpop offscreen_noflow">PubMed Central citations</div></li><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pubmed&DbFrom=books&Cmd=Link&LinkName=books_pubmed_refs&IdsFromResult=5557100" ref="log$=recordlinks">PubMed</a><div class="brieflinkpop offscreen_noflow">Links to PubMed</div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/20301656" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Adenosine Deaminase Deficiency.</a><span class="source">[GeneReviews(®). 1993]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Adenosine Deaminase Deficiency.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Hershfield M, Tarrant T. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">GeneReviews(®). 1993</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/39766110" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> The Functional Interaction Between Epstein-Barr Virus and MYC in the Pathogenesis of Burkitt Lymphoma.</a><span class="source">[Cancers (Basel). 2024]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> The Functional Interaction Between Epstein-Barr Virus and MYC in the Pathogenesis of Burkitt Lymphoma.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Solares S, León J, García-Gutiérrez L. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Cancers (Basel). 2024 Dec 18; 16(24). Epub 2024 Dec 18.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/30020687" ref="ordinalpos=1&linkpos=3&log$=relatedarticles&logdbfrom=pubmed">Immediate Hypersensitivity Reactions (Archived).</a><span class="source">[StatPearls. 2025]</span><div class="brieflinkpop offscreen_noflow">Immediate Hypersensitivity Reactions (Archived).<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Justiz Vaillant AA, Vashisht R, Zito PM. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">StatPearls. 2025 Jan</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/34033365" ref="ordinalpos=1&linkpos=4&log$=relatedarticles&logdbfrom=pubmed">Monoclonal Antibody Therapy For High-Risk Coronavirus (COVID 19) Patients With Mild To Moderate Disease Presentations (Archived).</a><span class="source">[StatPearls. 2025]</span><div class="brieflinkpop offscreen_noflow">Monoclonal Antibody Therapy For High-Risk Coronavirus (COVID 19) Patients With Mild To Moderate Disease Presentations (Archived).<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Aleem A, Vaqar S. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">StatPearls. 2025 Jan</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/20301551" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Sickle Cell Disease.</a><span class="source">[GeneReviews(®). 1993]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Sickle Cell Disease.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Bender MA, Carlberg K. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">GeneReviews(®). 1993</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=38261671" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=38261671" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c80ab8feee5b00ac1faf16">EBV-Associated Myopericarditis - StatPearls</a><div class="ralinkpop offscreen_noflow">EBV-Associated Myopericarditis - StatPearls<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c80ab76d1ec11b6f7ed3d5">Adverse Drug Reactions - StatPearls</a><div class="ralinkpop offscreen_noflow">Adverse Drug Reactions - StatPearls<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c80ab56d1ec11b6f7ec590">Benign and Malignant Iris Tumors - StatPearls</a><div class="ralinkpop offscreen_noflow">Benign and Malignant Iris Tumors - StatPearls<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c80ab3d5edb449bf62a0e4">Nonorganic Vision Loss - StatPearls</a><div class="ralinkpop offscreen_noflow">Nonorganic Vision Loss - StatPearls<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67c80ab26d1ec11b6f7eb119">Adlerian Therapy - StatPearls</a><div class="ralinkpop offscreen_noflow">Adlerian Therapy - StatPearls<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
|
||
|
||
<!-- Custom content below discovery portlets -->
|
||
<div class="col7">
|
||
|
||
</div>
|
||
</div>
|
||
</div>
|
||
|
||
<!-- Custom content after all -->
|
||
<div class="col8">
|
||
|
||
</div>
|
||
<div class="col9">
|
||
|
||
</div>
|
||
|
||
<script type="text/javascript" src="/corehtml/pmc/js/jquery.scrollTo-1.4.2.js"></script>
|
||
<script type="text/javascript">
|
||
(function($){
|
||
$('.skiplink').each(function(i, item){
|
||
var href = $($(item).attr('href'));
|
||
href.attr('tabindex', '-1').addClass('skiptarget'); // ensure the target can receive focus
|
||
$(item).on('click', function(event){
|
||
event.preventDefault();
|
||
$.scrollTo(href, 0, {
|
||
onAfter: function(){
|
||
href.focus();
|
||
}
|
||
});
|
||
});
|
||
});
|
||
})(jQuery);
|
||
</script>
|
||
</div>
|
||
<div class="bottom">
|
||
<script type="text/javascript">
|
||
var PBooksSearchTermData = {
|
||
highlighter: "bold",
|
||
dateTime: "03/05/2025 03:12:13",
|
||
terms: [
|
||
'2010'
|
||
]
|
||
};
|
||
</script>
|
||
<div id="NCBIFooter_dynamic">
|
||
<!--<component id="Breadcrumbs" label="breadcrumbs"/>
|
||
<component id="Breadcrumbs" label="helpdesk"/>-->
|
||
|
||
</div>
|
||
|
||
<div class="footer" id="footer">
|
||
<section class="icon-section">
|
||
<div id="icon-section-header" class="icon-section_header">Follow NCBI</div>
|
||
<div class="grid-container container">
|
||
<div class="icon-section_container">
|
||
<a class="footer-icon" id="footer_twitter" href="https://twitter.com/ncbi" aria-label="Twitter"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
||
<defs>
|
||
<style>
|
||
.cls-11 {
|
||
fill: #737373;
|
||
}
|
||
</style>
|
||
</defs>
|
||
<title>Twitter</title>
|
||
<path class="cls-11" d="M250.11,105.48c-7,3.14-13,3.25-19.27.14,8.12-4.86,8.49-8.27,11.43-17.46a78.8,78.8,0,0,1-25,9.55,39.35,39.35,0,0,0-67,35.85,111.6,111.6,0,0,1-81-41.08A39.37,39.37,0,0,0,81.47,145a39.08,39.08,0,0,1-17.8-4.92c0,.17,0,.33,0,.5a39.32,39.32,0,0,0,31.53,38.54,39.26,39.26,0,0,1-17.75.68,39.37,39.37,0,0,0,36.72,27.3A79.07,79.07,0,0,1,56,223.34,111.31,111.31,0,0,0,116.22,241c72.3,0,111.83-59.9,111.83-111.84,0-1.71,0-3.4-.1-5.09C235.62,118.54,244.84,113.37,250.11,105.48Z">
|
||
</path>
|
||
</svg></a>
|
||
<a class="footer-icon" id="footer_facebook" href="https://www.facebook.com/ncbi.nlm" aria-label="Facebook"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
||
<title>Facebook</title>
|
||
<path class="cls-11" d="M210.5,115.12H171.74V97.82c0-8.14,5.39-10,9.19-10h27.14V52l-39.32-.12c-35.66,0-42.42,26.68-42.42,43.77v19.48H99.09v36.32h27.24v109h45.41v-109h35Z">
|
||
</path>
|
||
</svg></a>
|
||
<a class="footer-icon" id="footer_linkedin" href="https://www.linkedin.com/company/ncbinlm" aria-label="LinkedIn"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
||
<title>LinkedIn</title>
|
||
<path class="cls-11" d="M101.64,243.37H57.79v-114h43.85Zm-22-131.54h-.26c-13.25,0-21.82-10.36-21.82-21.76,0-11.65,8.84-21.15,22.33-21.15S101.7,78.72,102,90.38C102,101.77,93.4,111.83,79.63,111.83Zm100.93,52.61A17.54,17.54,0,0,0,163,182v61.39H119.18s.51-105.23,0-114H163v13a54.33,54.33,0,0,1,34.54-12.66c26,0,44.39,18.8,44.39,55.29v58.35H198.1V182A17.54,17.54,0,0,0,180.56,164.44Z">
|
||
</path>
|
||
</svg></a>
|
||
<a class="footer-icon" id="footer_github" href="https://github.com/ncbi" aria-label="GitHub"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
||
<defs>
|
||
<style>
|
||
.cls-11,
|
||
.cls-12 {
|
||
fill: #737373;
|
||
}
|
||
|
||
.cls-11 {
|
||
fill-rule: evenodd;
|
||
}
|
||
</style>
|
||
</defs>
|
||
<title>GitHub</title>
|
||
<path class="cls-11" d="M151.36,47.28a105.76,105.76,0,0,0-33.43,206.1c5.28,1,7.22-2.3,7.22-5.09,0-2.52-.09-10.85-.14-19.69-29.42,6.4-35.63-12.48-35.63-12.48-4.81-12.22-11.74-15.47-11.74-15.47-9.59-6.56.73-6.43.73-6.43,10.61.75,16.21,10.9,16.21,10.9,9.43,16.17,24.73,11.49,30.77,8.79,1-6.83,3.69-11.5,6.71-14.14C108.57,197.1,83.88,188,83.88,147.51a40.92,40.92,0,0,1,10.9-28.39c-1.1-2.66-4.72-13.42,1-28,0,0,8.88-2.84,29.09,10.84a100.26,100.26,0,0,1,53,0C198,88.3,206.9,91.14,206.9,91.14c5.76,14.56,2.14,25.32,1,28a40.87,40.87,0,0,1,10.89,28.39c0,40.62-24.74,49.56-48.29,52.18,3.79,3.28,7.17,9.71,7.17,19.58,0,14.15-.12,25.54-.12,29,0,2.82,1.9,6.11,7.26,5.07A105.76,105.76,0,0,0,151.36,47.28Z">
|
||
</path>
|
||
<path class="cls-12" d="M85.66,199.12c-.23.52-1.06.68-1.81.32s-1.2-1.06-.95-1.59,1.06-.69,1.82-.33,1.21,1.07.94,1.6Zm-1.3-1">
|
||
</path>
|
||
<path class="cls-12" d="M90,203.89c-.51.47-1.49.25-2.16-.49a1.61,1.61,0,0,1-.31-2.19c.52-.47,1.47-.25,2.17.49s.82,1.72.3,2.19Zm-1-1.08">
|
||
</path>
|
||
<path class="cls-12" d="M94.12,210c-.65.46-1.71,0-2.37-.91s-.64-2.07,0-2.52,1.7,0,2.36.89.65,2.08,0,2.54Zm0,0"></path>
|
||
<path class="cls-12" d="M99.83,215.87c-.58.64-1.82.47-2.72-.41s-1.18-2.06-.6-2.7,1.83-.46,2.74.41,1.2,2.07.58,2.7Zm0,0">
|
||
</path>
|
||
<path class="cls-12" d="M107.71,219.29c-.26.82-1.45,1.2-2.64.85s-2-1.34-1.74-2.17,1.44-1.23,2.65-.85,2,1.32,1.73,2.17Zm0,0">
|
||
</path>
|
||
<path class="cls-12" d="M116.36,219.92c0,.87-1,1.59-2.24,1.61s-2.29-.68-2.3-1.54,1-1.59,2.26-1.61,2.28.67,2.28,1.54Zm0,0">
|
||
</path>
|
||
<path class="cls-12" d="M124.42,218.55c.15.85-.73,1.72-2,1.95s-2.37-.3-2.52-1.14.73-1.75,2-2,2.37.29,2.53,1.16Zm0,0"></path>
|
||
</svg></a>
|
||
<a class="footer-icon" id="footer_blog" href="https://ncbiinsights.ncbi.nlm.nih.gov/" aria-label="Blog">
|
||
<svg xmlns="http://www.w3.org/2000/svg" id="Layer_1" data-name="Layer 1" viewBox="0 0 40 40">
|
||
<defs><style>.cls-1{fill:#737373;}</style></defs>
|
||
<title>NCBI Insights Blog</title>
|
||
<path class="cls-1" d="M14,30a4,4,0,1,1-4-4,4,4,0,0,1,4,4Zm11,3A19,19,0,0,0,7.05,15a1,1,0,0,0-1,1v3a1,1,0,0,0,.93,1A14,14,0,0,1,20,33.07,1,1,0,0,0,21,34h3a1,1,0,0,0,1-1Zm9,0A28,28,0,0,0,7,6,1,1,0,0,0,6,7v3a1,1,0,0,0,1,1A23,23,0,0,1,29,33a1,1,0,0,0,1,1h3A1,1,0,0,0,34,33Z"></path>
|
||
</svg>
|
||
</a>
|
||
</div>
|
||
</div>
|
||
</section>
|
||
|
||
<section class="container-fluid bg-primary">
|
||
<div class="container pt-5">
|
||
<div class="row mt-3">
|
||
<div class="col-lg-3 col-12">
|
||
<p><a class="text-white" href="https://www.nlm.nih.gov/socialmedia/index.html">Connect with NLM</a></p>
|
||
<ul class="list-inline social_media">
|
||
<li class="list-inline-item"><a href="https://twitter.com/NLM_NIH" aria-label="Twitter" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
||
<style type="text/css">
|
||
.st20 {
|
||
fill: #FFFFFF;
|
||
}
|
||
|
||
.st30 {
|
||
fill: none;
|
||
stroke: #FFFFFF;
|
||
stroke-width: 8;
|
||
stroke-miterlimit: 10;
|
||
}
|
||
</style>
|
||
<title>Twitter</title>
|
||
<g>
|
||
<g>
|
||
<g>
|
||
<path class="st20" d="M192.9,88.1c-5,2.2-9.2,2.3-13.6,0.1c5.7-3.4,6-5.8,8.1-12.3c-5.4,3.2-11.4,5.5-17.6,6.7 c-10.5-11.2-28.1-11.7-39.2-1.2c-7.2,6.8-10.2,16.9-8,26.5c-22.3-1.1-43.1-11.7-57.2-29C58,91.6,61.8,107.9,74,116 c-4.4-0.1-8.7-1.3-12.6-3.4c0,0.1,0,0.2,0,0.4c0,13.2,9.3,24.6,22.3,27.2c-4.1,1.1-8.4,1.3-12.5,0.5c3.6,11.3,14,19,25.9,19.3 c-11.6,9.1-26.4,13.2-41.1,11.5c12.7,8.1,27.4,12.5,42.5,12.5c51,0,78.9-42.2,78.9-78.9c0-1.2,0-2.4-0.1-3.6 C182.7,97.4,189.2,93.7,192.9,88.1z"></path>
|
||
</g>
|
||
</g>
|
||
<circle class="st30" cx="124.4" cy="128.8" r="108.2"></circle>
|
||
</g>
|
||
</svg></a></li>
|
||
<li class="list-inline-item"><a href="https://www.facebook.com/nationallibraryofmedicine" aria-label="Facebook" rel="noopener noreferrer" target="_blank">
|
||
<svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
||
<style type="text/css">
|
||
.st10 {
|
||
fill: #FFFFFF;
|
||
}
|
||
|
||
.st110 {
|
||
fill: none;
|
||
stroke: #FFFFFF;
|
||
stroke-width: 8;
|
||
stroke-miterlimit: 10;
|
||
}
|
||
</style>
|
||
<title>Facebook</title>
|
||
<g>
|
||
<g>
|
||
<path class="st10" d="M159,99.1h-24V88.4c0-5,3.3-6.2,5.7-6.2h16.8V60l-24.4-0.1c-22.1,0-26.2,16.5-26.2,27.1v12.1H90v22.5h16.9 v67.5H135v-67.5h21.7L159,99.1z"></path>
|
||
</g>
|
||
</g>
|
||
<circle class="st110" cx="123.6" cy="123.2" r="108.2"></circle>
|
||
</svg>
|
||
</a></li>
|
||
<li class="list-inline-item"><a href="https://www.youtube.com/user/NLMNIH" aria-label="Youtube" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
||
<title>Youtube</title>
|
||
<style type="text/css">
|
||
.st4 {
|
||
fill: none;
|
||
stroke: #FFFFFF;
|
||
stroke-width: 8;
|
||
stroke-miterlimit: 10;
|
||
}
|
||
|
||
.st5 {
|
||
fill: #FFFFFF;
|
||
}
|
||
</style>
|
||
<circle class="st4" cx="124.2" cy="123.4" r="108.2"></circle>
|
||
<g transform="translate(0,-952.36218)">
|
||
<path class="st5" d="M88.4,1037.4c-10.4,0-18.7,8.3-18.7,18.7v40.1c0,10.4,8.3,18.7,18.7,18.7h72.1c10.4,0,18.7-8.3,18.7-18.7 v-40.1c0-10.4-8.3-18.7-18.7-18.7H88.4z M115.2,1058.8l29.4,17.4l-29.4,17.4V1058.8z"></path>
|
||
</g>
|
||
</svg></a></li>
|
||
</ul>
|
||
</div>
|
||
<div class="col-lg-3 col-12">
|
||
<p class="address_footer text-white">National Library of Medicine<br />
|
||
<a href="https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/@38.9959508,-77.101021,17z/data=!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb:0x19156f88b27635b8!8m2!3d38.9959508!4d-77.0988323" class="text-white" target="_blank" rel="noopener noreferrer">8600 Rockville Pike<br />
|
||
Bethesda, MD 20894</a></p>
|
||
</div>
|
||
<div class="col-lg-3 col-12 centered-lg">
|
||
<p><a href="https://www.nlm.nih.gov/web_policies.html" class="text-white">Web Policies</a><br />
|
||
<a href="https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office" class="text-white">FOIA</a><br />
|
||
<a href="https://www.hhs.gov/vulnerability-disclosure-policy/index.html" class="text-white" id="vdp">HHS Vulnerability Disclosure</a></p>
|
||
</div>
|
||
<div class="col-lg-3 col-12 centered-lg">
|
||
<p><a class="supportLink text-white" href="https://support.nlm.nih.gov/">Help</a><br />
|
||
<a href="https://www.nlm.nih.gov/accessibility.html" class="text-white">Accessibility</a><br />
|
||
<a href="https://www.nlm.nih.gov/careers/careers.html" class="text-white">Careers</a></p>
|
||
</div>
|
||
</div>
|
||
<div class="row">
|
||
<div class="col-lg-12 centered-lg">
|
||
<nav class="bottom-links">
|
||
<ul class="mt-3">
|
||
<li>
|
||
<a class="text-white" href="//www.nlm.nih.gov/">NLM</a>
|
||
</li>
|
||
<li>
|
||
<a class="text-white" href="https://www.nih.gov/">NIH</a>
|
||
</li>
|
||
<li>
|
||
<a class="text-white" href="https://www.hhs.gov/">HHS</a>
|
||
</li>
|
||
<li>
|
||
<a class="text-white" href="https://www.usa.gov/">USA.gov</a>
|
||
</li>
|
||
</ul>
|
||
</nav>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</section>
|
||
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentOmnitureBaseJS/InstrumentNCBIConfigJS/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js?v=1"> </script>
|
||
<script type="text/javascript" src="/portal/portal3rc.fcgi/static/js/hfjs2.js"> </script>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<!--/.page-->
|
||
</div>
|
||
<!--/.wrap-->
|
||
</div><!-- /.twelve_col -->
|
||
</div>
|
||
<!-- /.grid -->
|
||
|
||
<span class="PAFAppResources"></span>
|
||
|
||
<!-- BESelector tab -->
|
||
|
||
|
||
|
||
<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK599522&ncbi_domain=statpearls&ncbi_report=record&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK599522/&ncbi_pagename=EBV-Associated Myopericarditis - StatPearls - NCBI Bookshelf&ncbi_bookparttype=chapter&ncbi_app=bookshelf" /></noscript>
|
||
|
||
|
||
<!-- usually for JS scripts at page bottom -->
|
||
<!--<component id="PageFixtures" label="styles"></component>-->
|
||
|
||
|
||
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal106 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
||
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
||
|
||
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/4062932/4209313/4212053/4076480/3921943/3400083/3426610.js" snapshot="books"></script></body>
|
||
</html> |