Fatal parvoviral myocarditis: a case report and review of literature

Abstract

Background: Histologically documented cases of parvoviral myocarditis are exceedingly rare.

Case presentation: 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 tissue

Methods: DNA was extracted from tissue and serum and primers were used to amplify DNA sequences of parvovirus B19 using nested polymerase chain reaction (PCR).

Conclusion: The diagnosis of parvovirus should be considered in cases of fatal myocarditis, and diagnosis can be confirmed at autopsy by molecular techniques.

Figure 1

Histopathological findings in parvoviral myocarditis. 1A. Diffuse interstitial myocardial inflammatory infiltrate more prominent around interstitial capillaries and composed of macrophages and lymphocytes (20×). 1B. Hematoxilin-eosin stain showing vasocentric inflammation (40×). 1C-1D. CD68 positive macrophages were the most abundant cells present. (Figure 1C-10X Figure 1D-20X) 1E. Rare CD3 positive lymphocytes. 1F. Essentially negative CD20 immunohistochemical stain.