FATAL EPSTEIN-BARR-VIRUS MYOCARDITIS IN A CHILD WITH REPETITIVE MYOCARDITIS

Fatal Epstein-Barr virus (EBV) myocarditis occurred in a 9-year-old fe male with a history of two prior discrete episodes of myocarditis, the first associated with chicken pox and the second of undetermined orig in. Serologic studies during the fatal episode were characteristic of acute EBV infection, and EBV genome was detected by polymerase chain r eaction (PCR) amplification of DNA extracted from autopsy heart and li ver. PCRs for enteroviruses and cardiac viral culture were negative. A n intense mononuclear cell infiltrate in the myocardium consisted enti rely of T cells, without identifiable B cells. Human leukocyte antigen HLA-DR analysis using frozen tissue obtained postmortem revealed anti gens DR4 and DR13. DR4 is associated with some autoimmune disorders, a s well as idiopathic dilated cardiomyopathy. We postulate that an aber rant immune response, possibly associated with the DR4 locus, was resp onsible for the repetitive episodes of myocarditis in this patient.