title: Successful clearance of human parainfluenza virus type 2 viraemia with intravenous ribavirin and immunoglobulin in a patient with acute myocarditis.
abstract: Human parainfluenza virus (HPIV) infection as an aetiology of acute viral myocarditis is rare, with only few cases reported in the literature to date. Here we report a case of fulminant HPIV-2 myocarditis in a 47 year-old man with viraemia who was successfully treated with intravenous ribavirin and intravenous immunoglobulin (IVIG). There are currently no recommendations on the treatment of HPIV myocarditis. We are, to our knowledge, the first to report a patient with a documented HPIV-2 viraemia that subsequently cleared after the initiation of antiviral therapy. Although it is difficult to definitively attribute the patient's clinical improvement to ribavirin or IVIG alone, our case does suggest that clinicians may wish to consider initiating ribavirin and IVIG in patients with HPIV myocarditis and persistent viraemia not responding to supportive measures alone.
authors.affiliation: Department of Infectious Diseases, Singapore General Hospital, Singapore.
authors.forename: Shirin
authors.initials: S
authors.lastname: Kalimuddin
authors.forename: October M
authors.initials: OM
authors.lastname: Sessions
authors.forename: Yan'An
authors.initials: Y
authors.lastname: Hou
authors.forename: Eng Eong
authors.initials: EE
authors.lastname: Ooi
authors.forename: David
authors.initials: D
authors.lastname: Sim
authors.forename: Sivathasan
authors.initials: S
authors.lastname: Cumaraswamy
authors.forename: Teing Ee
authors.initials: TE
authors.lastname: Tan
authors.forename: Siang Hui
authors.initials: SH
authors.lastname: Lai
authors.forename: Chian Yong
authors.initials: CY
authors.lastname: Low
mesh_terms: D061605:Administration, Intravenous; D000998:Antiviral Agents / Q000008:administration & dosage*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009205:Myocarditis / Q000188:drug therapy* / Q000821:virology; D010223:Parainfluenza Virus 2, Human / Q000302:isolation & purification*; D012367:RNA, Viral / Q000235:genetics; D012254:Ribavirin / Q000008:administration & dosage*; D019351:Rubulavirus Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D012367:RNA, Viral; D012254:Ribavirin