Fatal parvoviral myocarditis: A case report and review of literature

Here, we report a 41-year old African American immunocompetent patient who died of parvoviral myocarditis after a 10 day illness characterized by fever, headaches, generalized arthralgias, and a maculopapular rash.Autopsy revealed an infiltrate myocarditis composed primarily of T-lymphocytes and macrophages associated with extensive myocardial fibrosis. The diagnosis of parvovirus was determined by polymerase chain reaction (PCR) on both pre-mortem serum and post-mortem myocardial tissueDNA was extracted from tissue and serum and primers were used to amplify DNAsequences of parvovirus B19 using nested polymerase chain reaction (PCR).The diagnosis of parvovirus should be considered in cases of fatal myocarditis, and diagnosis can be confirmed at autopsy by molecular techniques.Parvovirus B19 (PB19) was discovered in 1974 and is the only member of the family Parvoviridae known to be pathogenic in humans[1]. It is endemic in humans worldwide, as antiparvovirus IgG antibody is present in asymptomatic patients in the United States, Europe, and Asia[2]. Infection is generally self-limited and in children typically presents as erythema infectiosum. Other manifestations of parvovirus infection include hydrops fetalis, arthropathy, and acute hepatitis [3-6]. In immunocompromised patients, PB19 infection of erythropoetic cells may result in anemia, and occasionally acute lung infections[7].The most common etiologies are infectious agents, hypersensitivity responses, or immune-related injury[8]. However, the etiology might go unrecognized secondary to difficulties in identifying infectious agents. This is particularly truth for viruses in the early stage of infection before the virus is cleared by the immune system. The detection of viral genomes in endomyocardial biopsies by molecular techniques, especially PCR, has greatly expanded the list of viruses implicated in myocarditis. Initially, the molecular diagnosis of the viral etiology of myocarditis focused on the enterovirus