Fulminant myocarditis associated with parvovirus B19 infection in a child

Human parvovirus B19 (PVB19) is a DNA virus ransmitted via the respiratory route, through parenteral dministration of products derived from blood, and vertically rom mother to fetus (Heegaard and Brown, 2002). PVB19 auses erythema infectiosum, arthropathy, transient aplasic crisis, and hydrops fetalis, but there are few reports of fatal outcome involving myocarditis (Murry et al., 2001; apadogiannakis et al., 2002; Zack et al., 2005). The patient, a 5-year-old girl, was admitted to the emerency unit after a malaise with loss of conscience for 3 min ithout convulsing. She complained of headache and abdomnal pain over 2 days, with five vomiting episodes and two iarrheic stools in a context of familial gastroenteritis. The hild was pale, with blood pressure of 92/59 mmHg, heart ate of 145 beats/min, and temperature 35 ◦C. The oxygen aturation level was 99%. A few hours later, a new episode of malaise occurred with drop in blood pressure to 46/25 mmHg and a heart rate f 54 beats/min, accompanied by loss of consciousness and lotching of the skin. The child appeared to recover following dministration of isotonic fluids to counteract hypovolemia. linical examination did not reveal other abnormal findings. ranial computer tomography and cardiac examination were ormal. There were no indications of hepatosplenomegaly, bdominal mass, meningeal syndrome, dehydration, or espiratory distress syndrome. The complementary blood xaminations showed no abnormal modifications. Tropoine, C-reactive protein, and hemoglobin were within