title: Human herpesvirus 6-related fulminant myocarditis and hepatitis in an immunocompetent adult with fatal outcome.
abstract: A 59-year-old previously healthy man had flulike symptoms of fever and diarrhea for a week, which worsened despite treatment with antibiotics. After admission, his medical condition rapidly deteriorated with renal failure, heart failure, and a marked increase of aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase. The patient died of a cardiac arrhythmia 3 days after the admission. The autopsy showed diffuse myocarditis with a granulocytic and monocytic infiltrate, necrotizing arteritis of the coronary arteries, and fulminant hepatitis, with microvesicular steatosis and necrosis. Cell-free serum showed high copies of human herpesvirus 6 B variant DNA by polymerase chain reaction. Human herpesvirus 6 B was identified in the heart, liver, lung, and spleen by immunohistochemistry. No parvovirus B19 was evident in the heart by immunohistochemistry. Human herpesvirus 6 is increasingly found in association with myocarditis in immunocompromised patients; however, histopathologic features and the clinical severity of this disease have not yet been clearly defined. Only 4 to 5 cases of human herpesvirus 6 fulminant myocarditis have been reported, all in young children or immunosuppressed patients. To the best of our knowledge, this is the first case in the English literature of human herpesvirus 6 fulminant myocarditis and hepatitis in an immunocompetent adult with a fatal outcome. In addition, several pathologic features of our case have not been previously reported.
authors.affiliation: Department of Pathology, Summa Health System Barberton Hospital, Barberton, OH 44203, USA. ychang@barbhosp.com
authors.forename: Yilan L
authors.initials: YL
authors.lastname: Chang
authors.forename: Mark E
authors.initials: ME
authors.lastname: Parker
authors.forename: Gerard
authors.initials: G
authors.lastname: Nuovo
authors.forename: Joel B
authors.initials: JB
authors.lastname: Miller
mesh_terms: D017809:Fatal Outcome; D006505:Hepatitis / Q000473:pathology* / Q000503:physiopathology / Q000821:virology*; D015654:Herpesvirus 6, Human; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000473:pathology* / Q000503:physiopathology / Q000821:virology*; D016133:Polymerase Chain Reaction; D019349:Roseolovirus Infections / Q000473:pathology* / Q000503:physiopathology