Cytomegalovirus myocarditis in a healthy infant: Complete recovery after ganciclovir treatment.
OBJECTIVES: To report a case of acute myocarditis caused by cytomegalovirus infection in a 15-month-old immunocompetent infant completely recovered with ganciclovir treatment. DESIGN: Descriptive case report. SETTING: Pediatric intensive care unit in a general hospital. Patient: A 15-month-old healthy girl with acute, severe myocarditis. INTERVENTION: General supportive intensive care and mechanical ventilatory support, iv immunoglobulin, and iv ganciclovir. MEASUREMENTS AND MAIN RESULTS: Intensive supportive care including iv fluids, mechanical ventilatory support, diuretics (furosemide, spironolactone), digoxin, dobutamine, captopril, methylprednisolone, and iv immunoglobulin. Despite clinical stabilization, shortening fraction remained very poor at 17%. Addition of iv ganciclovir resulted in prompt and complete recovery of the cardiac muscle contractility with a shortening fraction of 35% that remained normal during a long follow-up period. CONCLUSIONS: Cytomegalovirus should be considered as a causative agent in acute myocarditis even in the normal, immunocompetent host. In such cases, addition of ganciclovir treatment should be strongly considered.
Dehtiar
Natalie
N
Department of Pediatrics (Drs. Dehtiar and Eherlichman), the Pediatric Intensive Care Unit (Drs. Picard and Kleid), the Department of Pediatric Cardiology (Dr. Glaser), and the Infectious Diseases Unit (Drs. Raveh and Schlesinger), Shaare Zedek Medical Center, Jerusalem, Israel.
Eherlichman
Matityahu
M
Picard
Elie
E
Kleid
David
D
Glaser
Joram
J
Raveh
David
D
Schlesinger
Yechiel
Y