Lamparter Steffen, Schoppet Michael, Pankuweit Sabine, Maisch Bernhard
Department of Internal Medicine and Cardiology, Philipps-University, Marburg, Germany.
Hum Pathol. 2003 Jul;34(7):725-8. doi: 10.1016/s0046-8177(03)00235-1.
Inflammatory heart disease is causally linked with progressive left ventricular dysfunction and congestive heart failure. In childhood, infection with parvovirus B19 (PVB19) is usually benign, causing erythema infectiosum. However, severe fetal PVB19 infection may be associated with hydrops fetalis and fetal death caused by myocarditis. Here we report a PVB19-induced myocarditis in a previously healthy 37-year-old patient admitted to the hospital because of chest pain and dyspnea due to left ventricular dysfunction. Four weeks after the onset of symptoms, we found lymphocytic infiltrates and PVB19 genome in left ventricular endomyocardial biopsy specimens. Consistently, acute PVB19 infection was indicated serologically by elevated IgM titers and the presence of PVB19 genome in peripheral blood lymphocytes. In conclusion, PVB19 infection may be complicated by acute myocarditis in immunocompetent adults. Because PVB19 myocarditis may progress to chronic dilated cardiomyopathy, early diagnosis by endomyocardial biopsy is important to initiate anti-inflammatory treatment.
炎症性心脏病与进行性左心室功能障碍和充血性心力衰竭存在因果关系。在儿童时期，感染细小病毒B19（PVB19）通常是良性的，会引起传染性红斑。然而，严重的胎儿PVB19感染可能与胎儿水肿和由心肌炎导致的胎儿死亡有关。在此，我们报告一例PVB19诱发的心肌炎，患者为一名37岁既往健康的男性，因左心室功能障碍导致胸痛和呼吸困难入院。症状出现四周后，我们在左心室心内膜活检标本中发现淋巴细胞浸润和PVB19基因组。同样，血清学检查显示IgM滴度升高以及外周血淋巴细胞中存在PVB19基因组，提示急性PVB19感染。总之，PVB19感染在免疫功能正常的成年人中可能并发急性心肌炎。由于PVB19心肌炎可能进展为慢性扩张型心肌病，通过心内膜活检进行早期诊断对于启动抗炎治疗很重要。
