Murry C E, Jerome K R, Reichenbach D D
Department of Pathology, University of Washington, Seattle, WA 98195, USA.
Hum Pathol. 2001 Mar;32(3):342-5. doi: 10.1053/hupa.2001.22743.
Infection with parvovirus B19 is common in children and typically causes mild illness. We report here the case of a 5-year-old girl who died suddenly, 2 weeks after the clinical diagnosis of a parvoviral infection (erythema infectiosum). Microscopic examination of the heart showed severe myocarditis with extensive T-cell and macrophage infiltration. Cultures, serology, and molecular analyses of serum for enteroviridae, adenovirus, influenza, varicella zoster, cytomegalovirus, and herpes simplex viruses were negative. Quantitative polymerase chain reaction (PCR) analysis for parvovirus B19 in peripheral blood, however, showed active infection (91,000 genomes/mL serum; 2.4 genomes/mononuclear cell). Despite the presence of myocarditis, immunostaining for parvoviral surface antigens was negative in the heart. Quantitative PCR analysis of paraffin sections showed that myocardial parvoviral content was significantly less than that of the normal appearing kidney and within the range predicted simply by tissue blood content. Thus, parvovirus B19 infection can be complicated by fatal myocarditis. Because the virus does not appear to have infected the heart, per se, we speculate that myocarditis arose from immunological cross-reaction to epitopes shared between the virus and the myocardium. HUM PATHOL 32:342-345.
细小病毒B19感染在儿童中很常见，通常引起轻症。我们在此报告一例5岁女孩的病例，该女孩在临床诊断为细小病毒感染（传染性红斑）2周后突然死亡。心脏显微镜检查显示严重心肌炎，伴有广泛的T细胞和巨噬细胞浸润。对血清进行肠道病毒科、腺病毒、流感病毒、水痘带状疱疹病毒、巨细胞病毒和单纯疱疹病毒的培养、血清学及分子分析均为阴性。然而，外周血中细小病毒B19的定量聚合酶链反应（PCR）分析显示存在活动性感染（91,000个基因组/mL血清；2.4个基因组/单核细胞）。尽管存在心肌炎，但心脏中细小病毒表面抗原的免疫染色为阴性。石蜡切片的定量PCR分析显示，心肌中细小病毒含量明显低于外观正常的肾脏，且仅在由组织血含量预测的范围内。因此，细小病毒B19感染可并发致命性心肌炎。由于病毒本身似乎并未感染心脏，我们推测心肌炎是由对病毒与心肌之间共享表位的免疫交叉反应引起的。《人类病理学》32:342 - 345。
