SICKLE-CELL ACUTE CHEST SYNDROME-ASSOCIATED WITH PARVOVIRUS B19 INFECTION - CASE SERIES AND REVIEW

Acute Chest Syndrome (ACS) continues to be a major source of morbidity and mortality among patients with sickle cell disease, It is characte rized by the presence of pleutitic chest pain, fever, rales on lung au scultation, and pulmonary infiltrates on chest X-ray [Castro et al: Bl ood 84:643-649, 1994], The pathophysiology of this disorder remains po orly understood leading to the descriptive term ''Acute Chest Syndrome '' designated by Charache et al. [Arch Intern Med 139:67-69, 1979], Ty pical bacterial pathogens are seldom isolated in adults, although they play a significant role in the pathogenesis of this entity in childre n, Until recently, the technology to accurately study viral infection as a precipitating cause of ACS has been unavailable. Parvovirus B19 i s being increasingly recognized as an important human pathogen, and ha s been established as the cause of transient ''aplastic crisis'' in pa tients with sickle cell disease [Saarien et al: Blood 67:11411-11417, 1986; Young: Sem Hematol 25:159-172, 1988], We present three patients with hemoglobin SC variant of sickle cell disease who developed ACS in association with acute parvovirus 619 infection, one of which died of respiratory failure, Parvovirus B19 infection was established by poly merase chain reaction for parvovirus B19 DNA, and the presence of parv ovirus B19 specific IgM antibodies, These cases suggest that parvoviru s 619 may be associated with more than self-limited illness in patient s with sickle cell disease, and that this ubiquitous virus may merit f urther study as a precipitating cause of ACS. (C) 1996 Wiley-Liss, Inc .