title: A fatal case of Human Herpesvirus 6 chronic myocarditis in an immunocompetent adult.
abstract: BACKGROUND
  Human Herpesvirus 6 (HHV-6) is an important cause of fulminant or acute viral myocarditis in immunocompromised or immunocompetent patients. However the physiopathological mechanisms of HHV-6 related acute myocarditis and the involvement of subsequent HHV-6 reactivation phases in the development of chronic cardiomyopathies remain to be assessed.
  
  
  OBJECTIVE
  To describe a case of fatal HHV-6 chronic myocarditis in an immunocompetent adult.
  
  
  METHODS
  Case report and detailed histological and viral diagnoses by combination of histology/immunohistochemistry and polymerase chain reaction techniques on cardiac tissues.
  
  
  RESULTS
  Histopathological analysis of ventricular tissues showed large interstitial and scarring fibrotic areas with a moderate mononuclear cell infiltrate compatible with histological aspect of chronic myocarditis. Detection of both HHV-6 by real-time PCR and viral glycoproteins in mononuclear and endothelial cells by immunohistochemistry evidenced an ongoing cardiac HHV-6 replication with viral late protein synthesis activity.
  
  
  CONCLUSIONS
  This case report indicates that HHV-6 can establish a chronic active myocarditis leading to heart failure in immunocompetent subjects.
authors.affiliation: Clinical and Molecular Virology Unit, University Hospital and EA-4303 Faculty of Medicine, Reims, France. nleveque@chu-reims.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Leveque
authors.forename: Camille
authors.initials: C
authors.lastname: Boulagnon
authors.forename: Camille
authors.initials: C
authors.lastname: Brasselet
authors.forename: François
authors.initials: F
authors.lastname: Lesaffre
authors.forename: David
authors.initials: D
authors.lastname: Boutolleau
authors.forename: Damien
authors.initials: D
authors.lastname: Metz
authors.forename: Paul
authors.initials: P
authors.lastname: Fornes
authors.forename: Laurent
authors.initials: L
authors.lastname: Andreoletti
mesh_terms: D001706:Biopsy; D045744:Cell Line, Tumor; D002908:Chronic Disease; D017809:Fatal Outcome; D005260:Female; D015654:Herpesvirus 6, Human / Q000235:genetics*; D006801:Humans; D007121:Immunocompetence; D008875:Middle Aged; D009205:Myocarditis / Q000473:pathology / Q000821:virology*; D009206:Myocardium / Q000473:pathology; D019349:Roseolovirus Infections / Q000473:pathology / Q000821:virology*