title: Fatal course of parvovirus B19-associated myocarditis in a female liver transplant recipient.
abstract: Acute myocarditis may result in severe hemodynamic compromise with fatal outcome. Furthermore, recent studies suggest myocarditis as a major cause of sudden unexpected death. A variety of cardiotropic viral, rickettsial, and bacterial infectious agents have been identified to date. Parvovirus B19 (PVB19) is usually benign in childhood, but it may also cause death due to myocarditis. We present here the case of an adult female who presented with fatigue, dyspnea on exertion, and orthostatic dizziness 8 months after successful liver transplantation. Cardiologic work-up, including left ventricular endomyocardial biopsy, revealed acute myocarditis secondary to PVB19. Since no specific therapy for this virus is available, the patient was treated symptomatically with an angiotensin-converting enzyme inhibitor plus beta-blocker and diuretics. After a period of stabilization, new-onset rapid atrial fibrillation caused acute low-output syndrome within 14 days after hospital admission. The patient eventually died because of refractory cardiogenic shock. In conclusion, to our knowledge this is the first report of PVB19-induced myocarditis confirmed by detection of viral genome in myocardium in a liver transplant recipient.
authors.affiliation: Clinical Division of Cardiology, Innsbruck Medical University, Innsbruck, Austria. patrycja.jonetzko@uklibk.ac.at
authors.forename: Patrycja
authors.initials: P
authors.lastname: Jonetzko
authors.forename: Ivo
authors.initials: I
authors.lastname: Graziadei
authors.forename: Karin
authors.initials: K
authors.lastname: Nachbaur
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Vogel
authors.forename: Sabine
authors.initials: S
authors.lastname: Pankuweit
authors.forename: Ralf
authors.initials: R
authors.lastname: Zwick
authors.forename: Otmar
authors.initials: O
authors.lastname: Pachinger
authors.forename: Gerhard
authors.initials: G
authors.lastname: Poelzl
mesh_terms: D000208:Acute Disease; D000368:Aged; D004279:DNA, Viral / Q000235:genetics; D017809:Fatal Outcome; D005260:Female; D016679:Genome, Viral; D006801:Humans; D016031:Liver Transplantation; D009205:Myocarditis / Q000150:complications / Q000821:virology*; D010322:Parvoviridae Infections / Q000150:complications*; D016732:Parvovirus B19, Human / Q000235:genetics; D011183:Postoperative Complications / Q000821:virology*; D012770:Shock, Cardiogenic / Q000209:etiology
chemical_list: D004279:DNA, Viral