Fatal parvovirus myocarditis in a 5-year-old girl

• Published in: Human pathology Vol. 32; no. 3; pp. 342 - 345
• Main Authors: Murry, Charles E., Jerome, Keith R., Reichenbach, Dennis D.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2001; Elsevier
• Subjects: Antigens, Viral - analysis; Biological and medical sciences; Child, Preschool; DNA, Viral - blood; Erythema Infectiosum - diagnosis; Fatal Outcome; Female; Heart - virology; Human viral diseases; Humans; Infectious diseases; Medical sciences; myocarditis; Myocarditis - pathology; Myocarditis - virology; paraffin sections; Parvoviridae Infections - diagnosis; Parvoviridae Infections - pathology; parvovirus B19; Parvovirus B19, Human; Polymerase Chain Reaction; Viral cardiopathies; Viral diseases; paraffin sections; myocarditis; VP; HSV; parvovirus B19; polymerase chain reaction; PCR; Human; Immunohistochemistry; Virological exploration; Cardiovascular disease; Erythrovirus; Myocardial disease; Virus B19; Infection; Virus; Case study; Myocarditis; Polymerase chain reaction; Pathology; Microbiological investigation; Parvoviridae; Heart disease; Viral disease; Female; Molecular biology; Child; Parvovirinae
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1053/hupa.2001.22743

Infection with parvovirus B19 is common in children and typically causes mild illness. We report here the case of a 5-year-old girl who died suddenly, 2 weeks after the clinical diagnosis of a parvoviral infection (erythema infectiosum). Microscopic examination of the heart showed severe myocarditis with extensive T-cell and macrophage infiltration. Cultures, serology, and molecular analyses of serum for enteroviridae, adenovirus, influenza, varicella zoster, cytomegalovirus, and herpes simplex viruses were negative. Quantitative polymerase chain reaction (PCR) analysis for parvovirus B19 in peripheral blood, however, showed active infection (91,000 genomes/mL serum; 2.4 genomes/mononuclear cell). Despite the presence of myocarditis, immunostaining for parvoviral surface antigens was negative in the heart. Quantitative PCR analysis of paraffin sections showed that myocardial parvoviral content was significantly less than that of the normal appearing kidney and within the range predicted simply by tissue blood content. Thus, parvovirus B19 infection can be complicated by fatal myocarditis. Because the virus does not appear to have infected the heart, per se, we speculate that myocarditis arose from immunological cross-reaction to epitopes shared between the virus and the myocardium. HUM PATHOL 32:342-345. Copyright © 2001 by W.B. Saunders Company