Myocarditis Attributable to Monkeypox Virus Infection in 2 Patients, United States, 2022

Abstract

We report 2 immunocompetent and otherwise healthy adults in the United States who had monkeypox and required hospitalization for viral myocarditis. Both patients were unvaccinated against orthopoxviruses. They had shortness of breath or chest pain and elevated cardiac biomarkers. No immediate complications were observed. They were discharged home after symptoms resolved.

Keywords: United States; immunocompetent; monkeypox; myocarditis; orthopox; sexually transmitted infections; unvaccinated; vaccine-preventable diseases; viruses.

Figure 1

Timeline of events for 2 immunocompetent patients with monkeypox complicated by myocarditis, United States. A) A healthy 32-year-old man (patient 1) had chest pain and shortness of breath 7 days after a prodrome of headache, fatigue, malaise, and cervical lymphadenopathy and 2 days after the rash. Symptoms resolved after 10 days of illness onset and 1 day after initiation of tecovirimat. The patient received supportive care only for myocarditis. B) A healthy 37-year-old man (patient 2) had shortness of breath and decreased exercise tolerance 6 days after illness onset with bilateral inguinal lymphadenopathy and 4 days after the rash. Shortness of breath improved after 12 days of illness onset, and exercise tolerance normalized after 20 days. The patient received supportive care only for both monkeypox and myocarditis.

Figure 2

An electrocardiogram of a healthy 37-year-old man (patient 2) with monkeypox, shortness of breath, and decreased exercise tolerance shows normal sinus rhythm with T wave inversions in the inferior and anterolateral leads.