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Fatal acute myocarditis in an infant with human herpesvirus 6 infection

Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
Department of Pediatrics, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
Special Reference Laboratories Inc, Tokyo, Japan

Dr Yoshikawa, Laboratory of Virology, Research Institute for Disease Mechanism and Control, Nagoya University School of Medicine, Nagoya, Aichi, 4668550, Japan tetsushi{at}med.nagoya-u.ac.jp A 5 month old girl had typical clinical features of acute myocarditis just after the febrile period of exanthem subitum and died immediately. She had been healthy, with normal development, and there was no family history of particular note. Myocardial postmortem findings were compatible with acute myocarditis. Although the isolation of human herpesvirus 6 (HHV-6) was not attempted, positive IgM antibody to HHV-6 was detected in the patient's serum. Moreover, HHV-6 variant B DNA was detected in several tissues, including myocardium, by the polymerase chain reaction (PCR). In contrast, antibody responses to human herpesvirus 7, another causal agent of exanthem subitum, were not found, and enteroviral RNA was not detected in myocardial tissues by reverse transcription PCR. Apoptotic changes were seen in infiltrating cells within the myocardial tissues by means of the TUNEL method. HHV-6 antigen was not detected in several tissues (including myocardium) by immunohistochemical analysis. In conclusion, HHV-6 may have been the causative agent of fatal acute myocarditis in this infant.

Key Words: human herpesvirus 6 • myocarditis • polymerase chain reaction

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