A Rare Case of Mumps Myocarditis

Berous Marion, Lattuca Benoit, Akodad Mariama, Monnin-Bares Valérie, Roubille François

Berous Marion, Lattuca Benoit, Akodad Mariama, Roubille François, Department of cardiology, Arnaud de Villeneuve University Hospita, Montpellier, France
Monnin-Bares Valérie, Department of radiology, Arnaud de Villeneuve University Hospita, Montpellier, France

Correspondence to: François Roubille, Department of cardiology, Arnaud de Villeneuve University Hospita, Montpellier, France
Email: benoit.lattuca@gmail.com
Telephone: +33-467335953
Fax: + 33-467336230
Received: October 11, 2014
Revised: November 4, 2014
Accepted: November 11, 2014
Published online: June 10, 2015


“We report the case of a 26-years-old man hospitalized with a typical clinical presentation of Mumps. Indeed, he was admitted for epiglottitis and developed during his hospitalization an orchiepididymitis, a pancreatitis and a rare but well-known complication of this infection: myocarditis confirmed by Cardiac MRI.

Key words: Myocarditis; Mumps; Cardiac MRI; MMR vaccine

© 2015 The Authors. Published by ACT Group Ltd.

Berous M, Lattuca B, Akodad M, Monnin-Bares V, Roubille F. A Rare Case of Mumps Myocarditis. Journal of Cardiology and Therapy 2015; 2(3): 329-331 Available from: URL: http://www.ghrnet.org/index.php/jct/article/view/1209


Mumps is a human viral disease affecting usually the salivary glands, pancreas and testis. Myocarditis is a rare but well-known complication of this infection whose incidence has been reported between 4 to 15 % of the cases of mumps in old series[1]. We report the case of mumps myocarditis occurring in a typical presentation of the disease.

Case Report

A 26-years-old man was admitted at hospital to manage an epiglottitis. He had no relevant past medical history except a benign asthma and no recent contact with infected people. The patient consulted for persistent fever to 106°F and right sub- and retro-mandibular adenopathies in spite of antibiotherapy by Amoxicillin/clavulanic acid. Blood analysis revealed an elevation of inflammatory markers: CRP 406 mg/L (normal value<3mg/L), white blood cell count 12×109/l. The cervical computed tomography (CT) scan as well as the nasofibroscopy confirmed the epiglottitis diagnosis without necrotic, collected or obstructive complications and associated to latero-cervical localized cellulitis[1](Figure 1). An antibiotherapy with metronidazole/cefotaxime was started.

Two day later he complained from left testicular pain associated to a scrotal inflammation consistent with the diagnosis of orchiepididymitis. Moreover the blood analysis showed a lipase elevation to 828 UI/L (normal value<60UI/L) without abdominal pain; an abdominal scan was performed and showed a minor increase in volume of the pancreas without necrotic signs matching with a Balthazar B score pancreatitis.

Taken altogether these typical presentations of mumps combining: epiglottitis, orchiepididymitis, pancreatitis and negative blood culture, antibiotherapy was stopped. The patient had been never given the Measles-Mumps-Rubella (MMR) vaccine.

Five day later, he had a retrosternal chest pain increasing with inspiration, electrocardiogram revealed T negative waves in the inferior and apicolateral territory[2] (Figure 2), high-sensitivity troponin assay was elevated to 585 ng/L (N<14 ng/L) therefore the patient was hospitalized in the intensive care unit of cardiology.

There was no sign of cardiac heart failure. Tranthoracic echocardiogram showed normal left ventricular segmental kinetic, volumes and ejection fraction and a minor pericardial effusion of 6mm in diastole near the right ventricle. Myocarditis diagnosis was stated and treatment by colchicin, aspirin and beta-blockers was begun. Physical activity was prohibited until the next cardiology consultation one month later.

Cardiovascular magnetic resonance imaging (Cardiac-MRI) confirmed the diagnosis of myocarditis showing multiple sub-epicardial and mid-myocardial late enhancement foci in anterior, inferior and apical territories[3] (Figure 3). All the routine serologies were negative including the mumps serology. However, the methods used in our center may lack of sensitivity if the serology test is realized too early and a negative result does not exclude the diagnosis in cases of strong clinical suspicion.

The evolution was favorable without development of heart failure signs or arrhythmia and the patient was discharged few days later.


We report here a typical case of mumps associating epiglottitis, orchiepididymitis, pancreatitis and a rare but well-known complication: myocarditis[2,3]. Pujol suggested for the first time in 1918 that myocarditis could be a complication of mumps. Later, Rosenberg in 1945 described 15% of electrocardiogram abnormalities in the cases of mumps contrasting with 4% for Bengtsson in 1954[1].

Myocarditis occurs usually in the first week of the disease and electrocardiogram abnormalities disappear few weeks later but can persist in rare cases. Few cases of life-threatening[4,5] mumps myocarditis are described in the literature: cardiac arrest due to complete atrioventricular block persistent in spite of the medical treatment and requiring pacemaker implantation[6], cardiogenic shock requiring circulatory assist device[7], severe left ventricular dysfunction associated with apical thrombus and responsible for systemic emboli, progression to dilated cardiomyopathy[8,9] and so on. These few cases remain very uncommon and the evolution is generally benign as reported there.

This case underlines the necessity to promote the MMR vaccine generalization in the population that permits to eradicate this disease occurring by seasonal epidemics usually at the end of winter and spring. Indeed very few cases of myocarditis mumps have been reported in the literature in France and Europe in the last ten years probably due to a more frequent vaccination.


There are no conflicts of interest with regard to the present study.


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Peer reviewers: Sigita Glaveckaite MD, PhD, Cardiology and angiology centre, Vilnius University hospital Santariskiu klinikos, Santariskiu 2, LT 08661, Vilnius; Lithuania Makram, Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia.


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