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Background: Cervicitis, an infectious or noninfectious inflammation of the cervix, encompasses a wide range of clinical conditions, from asymptomatic infections to severe lesions, making its diagnosis difficult. Acute cervicitis may develop into pelvic inflammatory disease. In patients with cervicitis, current guidelines recommend testing for herpes simplex virus when external genital lesions are present. Here, we present the case of a patient with an atypical primary herpes simplex virus 2 infection manifesting as cervicitis without genital lesions., Case Presentation: A 29-year-old Caucasian woman was hospitalized for pelvic inflammatory disease. The patient complained of severe suprapubic pain, fever, and heavy vaginal discharge. The external genitalia were unremarkable, so empirical antibiotic treatment was initiated. Despite 48 hours of well-administered antibiotic therapy, her complaints persisted. Polymerase chain reaction for possible microbial causes was negative for Chlamydia trachomatis and Neisseria gonorrhoeae. There was no bacterial vaginosis. Repeat gynecological examinations with endovaginal ultrasound revealed an enlarged cervix, and pelvic magnetic resonance imaging supported a diagnosis of cervicitis. At this point, additional screening for other sexually transmitted infections and infectious disease-related etiologies of cervicitis was performed, and the polymerase chain reaction analysis of newly isolated samples was positive for herpes simplex virus 2. No antiviral treatment was initiated given the delay in diagnosing herpes simplex virus 2 infection and the slow but spontaneous abatement of symptoms., Conclusion: Herpes simplex virus infection should be considered as a possible cause of cervicitis, even in the absence of typical genital lesions. Early detection of herpes simplex virus allows early treatment, helping to reduce the duration and severity of symptoms and therefore potentially reducing recurrences and improving disease control. These data and data from future cases might spur changes in the guidelines on cervicitis testing and treatment., (© 2024. The Author(s).)

The study was designed to assess the accuracy of contrast-enhanced balanced steady-state free precession (cine-SSFP) CMR imaging sequences to exhibit myocardial hyperemia in acute myocarditis, which has for a long time been investigated in some centers using early gadolinium enhancement (EGE) sequence. Contrast-enhanced cine-SSFP (CESSFP) sequences were compared to precontrast cine-SSFP sequences to calculate the early cine-contrast enhancement in 36 consecutive patients with acute myocarditis and 36 controls matched for age and gender. Four-chamber views images were obtained in each subject before and after gadolinium injection. Absolute and relative left ventricular myocardial enhancement of the overall myocardium, then separately of the lateral wall and interventricular septum was analyzed in telediastole. Myocarditis patients displayed higher cine-SSFP absolute enhancement than controls (overall left ventricular myocardium 2.38 ± 0.33 vs 1.84 ± 0.31; lateral wall 2.45 ± 0.35 vs 1.83 ± 0.32; and septum 2.26 ± 0.29 vs 1.82 ± 0.29, p < 0.0001 for all). Less significant differences were observed for the relative enhancement (p < 0.05 for all). Using ROC curves, the optimal threshold value of absolute enhancement to diagnose acute myocarditis was 2.05 (sensitivity: 86%; specificity: 81%). Given the simplicity of use, contrast-enhanced cine-SSFP sequences should be used as an additional diagnostic tool to detect hyperemia in acute myocarditis patients., (© 2022. Springer Japan KK, part of Springer Nature.)