title: Active, fulminant, lethal myocarditis associated with parvovirus B19 infection in an infant.
abstract: We report a case of fulminant myocarditis in an 11-month-old female infant who had no other clinical signs of parvovirus infection. The patient presented with severe respiratory distress and died in sudden cardiac arrest 3 h after admission. The clinical presentation was similar to that of an asthmatic attack. Autopsy revealed signs of acute lymphocytic myocarditis. Parvovirus DNA was demonstrated by polymerase chain reaction (PCR) analysis of tissue sections obtained from the heart, lungs, liver, kidneys, and spleen. Transmission electron microscopy of myocardial tissue showed crystalline arrays with the appearance of parvovirus. The results of immunohistochemical analysis for the detection of parvovirus antigens were negative, and no viral inclusions were demonstrable. We suggest that the current diagnostic procedure underestimates the prevalence of parvovirus-associated myocarditis. PCR analysis should be used as a complement in suspected cases, to enhance the rate of detection of the infection and to reach a correct diagnosis.
authors.affiliation: Department of Pathology, Karolinska Institute, Huddinge University Hospital, 14186, Stockholm, Sweden. nipa@labd01.hs.sll.se
authors.forename: Nikos
authors.initials: N
authors.lastname: Papadogiannakis
authors.forename: Thomas
authors.initials: T
authors.lastname: Tolfvenstam
authors.forename: Björn
authors.initials: B
authors.lastname: Fischler
authors.forename: Oscar
authors.initials: O
authors.lastname: Norbeck
authors.forename: Kristina
authors.initials: K
authors.lastname: Broliden
mesh_terms: D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D007223:Infant; D009205:Myocarditis / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000821:virology*; D010322:Parvoviridae Infections / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000821:virology; D016732:Parvovirus B19, Human / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction
chemical_list: D004279:DNA, Viral