Parvovirus B19 myocarditis in a young man with previous non-bacterial meningitis

History and clincal findings: A 22-year old man presented with fatigue, dyspnoe NYHA III and presyncopes that had persisted since a non-bacterial meningitis 3 months before. Investigations: Transthoracic echocardiography revealed a dilated left ventricle with an ejection fraction (EF) reduced to 35 40% due to global hypokinesia. No pericardial effusion was seen; ECG and lung function test were normal. Serological, immunological and microbiological tests as well as nested PCR analysis of blood leucocytes for detection of cardiotropic pathogens were inconclusive. In endomyocardial biopsies retrieved from the left ventricular posterolateral wall, a chronic macrophage-rich myocarditis was shown by histopathology and, in addition, Parvovirus B 19 was identified as specific pathogen by use of nested PCR analysis. Treatment and course: At physical rest and with ACE inhibitor therapy (2.5 mg ramipril/day), heart failure decreased steadily. Follow-up echocardiography 1 month later revealed a left ventricle that was only slightly dilated with an EF of 50%. 3 months later, the patient was markedly more load-bearing; the EF amounted to 55-60%. Conclusions: Parvovirus B19 should be regarded as potential pathogen in case of suspected myocarditis in adulthood. Whether the previous non-bacterial meningitis was also attributable to this specific pathogen, remains open. Of note, however, the present case report by demonstrating a localized myocardial Parvovirus B19 infection without detectable systemic infection underscores the importance of molecular tests for diagnostic accuracy in manifest organ failure.