International Journal of Legal Medicine

, Volume 133, Issue 2, pp 553–560 | Cite as

Fatal parvovirus B19 infections: a report of two autopsy cases

  • Hsuan-Yun Hu
  • Shyh-Yuh Wei
  • Wei-Hsiang Huang
  • Chih-Hsin PanEmail author
Case Report


Parvovirus B19 (PVB19) commonly infects children and is usually asymptomatic. Lethal outcomes of PVB19 infection are unusual; nevertheless, the two cases reported here are rare examples of PVB19-induced hemophagocytic syndrome and myocarditis in infants and children. The two cases show the indisputable usefulness of immunohistochemistry and in situ hybridization in the detection of PVB19. In the death investigations, histopathological examinations provided stronger evidence than did serology or molecular biology. The cases also highlight the importance of forensic autopsy in vaccine-related death. As vaccine-related deaths are what people fear and may cause declines in vaccination rates, it is important to clarify deaths temporally or causally associated with vaccine administration.


Parvovirus b19 Vaccine-related death Hemophagocytic syndrome Fulminant lymphocytic myocarditis 



The authors extend particular appreciation to Dr. Jung-Jung Mu and Dr. Sung-Hsi Wei for their experimental help and clinical data. For this type of study, formal consent was not required.


This study was supported by grants (103-1301-05-05-03, 104-1301-05-05-06, 105-1301-05-05-01, and 106-1301-05-04-02) from the Ministry of Justice, Taiwan. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

Informed consent

The article does not include participants from whom informed consent was required.


  1. 1.
    Heegaard ED, Brown KE (2002) Human parvovirus B19. Clin Microbiol Rev 15:485–505CrossRefGoogle Scholar
  2. 2.
    Chorba T, Coccia P, Holman RC, Tattersall P, Anderson LJ, Sudman J, Young NS, Kurczynski E, Saarinen UM, Moir R, Lawrence DN, Jason JM, Evatt B (1986) The role of parvovirus B19 in aplastic crisis and erythema infectiosum (fifth disease). J Infect Dis 154:383–393CrossRefGoogle Scholar
  3. 3.
    Bell LM, Naides SJ, Stoffman P, Hodinka RL, Plotkin SA (1989) Human parvovirus B19 infection among hospital staff members after contact with infected patients. N Engl J Med 321:485–491. CrossRefGoogle Scholar
  4. 4.
    Dijkmans AC, de Jong EP, Dijkmans BA et al (2012) Parvovirus B19 in pregnancy: prenatal diagnosis and management of fetal complications. Curr Opin Obstet Gynecol 24:95–101. CrossRefGoogle Scholar
  5. 5.
    Centers for Disease Control (CDC) (1989) Risks associated with human parvovirus B19 infection. MMWR Morb Mortal Wkly Rep 38:81–88 93–7Google Scholar
  6. 6.
    Kaya Z, Ozturk G, Gursel T, Bozdayi G (2005) Spontaneous resolution of hemophagocytic syndrome and disseminated intravascular coagulation associated with parvovirus b19 infection in a previously healthy child. Jpn J Infect Dis 58:149–151Google Scholar
  7. 7.
    Papadogiannakis N, Tolfvenstam T, Fischler B, Norbeck O, Broliden K (2002) Active, fulminant, lethal myocarditis associated with parvovirus B19 infection in an infant. Clin Infect Dis 35:1027–1031. CrossRefGoogle Scholar
  8. 8.
    Dina J, Vabret A, Rambaud C, Checoury A, Gouarin S, Petitjean J, Freymuth F (2008) Fulminant myocarditis associated with parvovirus B19 infection in a child. J Clin Virol 42:70–71. CrossRefGoogle Scholar
  9. 9.
    Koehl B, Oualha M, Lesage F, Rambaud C, Canioni D, Hubert P, Leruez-Ville M (2012) Fatal parvovirus B19 myocarditis in children and possible dysimmune mechanism. Pediatr Infect Dis J 31:418–421. CrossRefGoogle Scholar
  10. 10.
    Ropeik D (2013) How society should respond to the risk of vaccine rejection. Hum Vaccin Immunother 9:1815–1818. CrossRefGoogle Scholar
  11. 11.
    Yeh SP, Chiu CF, Lee CC, Peng CT, Kuan CY, Chow KC (2004) Evidence of parvovirus B19 infection in patients of pre-eclampsia and eclampsia with dyserythropoietic anaemia. Br J Haematol 126:428–433. CrossRefGoogle Scholar
  12. 12.
    Saint-Martin J, Choulot JJ, Bonnaud E, Morinet F (1990) Myocarditis caused by parvovirus. J Pediatr 116:1007–1008CrossRefGoogle Scholar
  13. 13.
    Saint-Martin J, Bonnaud E, Morinet F, Choulot JJ, Mensire A (1991) Acute parvovirus myocarditis with fatal outcome. Pediatrie 46:597–599Google Scholar
  14. 14.
    Orth T, Herr W, Spahn T et al (1997) Human parvovirus B19 infection associated with severe acute perimyocarditis in a 34-year-old man. Eur Heart J 18:524–525CrossRefGoogle Scholar
  15. 15.
    Bultmann BD, Klingel K, Sotlar K et al (2003) Fatal parvovirus B19-associated myocarditis clinically mimicking ischemic heart disease: an endothelial cell-mediated disease. Hum Pathol 34:92–95. CrossRefGoogle Scholar
  16. 16.
    Bal A, Mishra B, Singh N, Das A, Jindal SK (2009) Fulminant parvovirus B19-associated pancarditis with haemophagocytic lympho-histiocytosis in an immunocompetent adult. APMIS 117:773–777. CrossRefGoogle Scholar
  17. 17.
    Jonetzko P, Graziadei I, Nachbaur K, Vogel W, Pankuweit S, Zwick R, Pachinger O, Poelzl G (2005) Fatal course of parvovirus B19-associated myocarditis in a female liver transplant recipient. Liver Transpl 11:463–466. CrossRefGoogle Scholar
  18. 18.
    Juhasz Z, Tiszlavicz L, Kele B, Terhes G, Deak J, Rudas L, Kereszty E (2014) Sudden cardiac death from parvovirus B19 myocarditis in a young man with Brugada syndrome. J Forensic Legal Med 25:8–13. CrossRefGoogle Scholar
  19. 19.
    Enders G, Dotsch J, Bauer J, Nutzenadel W, Hengel H, Haffner D, Schalasta G, Searle K, Brown KE (1998) Life-threatening parvovirus B19-associated myocarditis and cardiac transplantation as possible therapy: two case reports. Clin Infect Dis 26:355–358CrossRefGoogle Scholar
  20. 20.
    Beghetti M, Gervaix A, Haenggeli CA, Berner M, Rimensberger PC (2000) Myocarditis associated with parvovirus B19 infection in two siblings with merosin-deficient congenital muscular dystrophy. Eur J Pediatr 159:135–136CrossRefGoogle Scholar
  21. 21.
    Murry CE, Jerome KR, Reichenbach DD (2001) Fatal parvovirus myocarditis in a 5-year-old girl. Hum Pathol 32:342–345. CrossRefGoogle Scholar
  22. 22.
    Rohayem J, Dinger J, Fischer R, Klingel K, Kandolf R, Rethwilm A (2001) Fatal myocarditis associated with acute parvovirus B19 and human herpesvirus 6 coinfection. J Clin Microbiol 39:4585–4587. CrossRefGoogle Scholar
  23. 23.
    Dettmeyer R, Kandolf R, Baasner A, Banaschak S, Eis-Hubinger AM, Madea B (2003) Fatal parvovirus B19 myocarditis in an 8-year-old boy. J Forensic Sci 48:183–186Google Scholar
  24. 24.
    Respondek M, Bratosiewicz J, Pertynski T, Liberski PP (1997) Parvovirus particles in a fetal-heart with myocarditis: ultrastructural and immunohistochemical study. Arch Immunol Ther Exp 45:465–470Google Scholar
  25. 25.
    Hichijo A, Morine M (2014) A case of fetal parvovirus b19 myocarditis that caused terminal heart failure. Case Rep Obstet Gynecol 2014:463571. Google Scholar
  26. 26.
    Schenk T, Enders M, Pollak S, Hahn R, Huzly D (2009) High prevalence of human parvovirus B19 DNA in myocardial autopsy samples from subjects without myocarditis or dilative cardiomyopathy. J Clin Microbiol 47:106–110. CrossRefGoogle Scholar
  27. 27.
    Koepsell SA, Anderson DR, Radio SJ (2012) Parvovirus B19 is a bystander in adult myocarditis. Cardiovasc Pathol 21:476–481. CrossRefGoogle Scholar
  28. 28.
    Wang YC, Liu DJ, Ma LN, Liu MJ, Sheng GY, Zhao XM (2015) Clinical features of childhood hemophagocytic syndrome and its association with human parvovirus B19 infection. Zhongguo Dang Dai Er Ke Za Zhi 17:26–30. [pii]
  29. 29.
    Mayama M, Yoshihara M, Kokabu T, Oguchi H (2014) Hemophagocytic lymphohistiocytosis associated with a parvovirus B19 infection during pregnancy. Obstet Gynecol 124:438–441. CrossRefGoogle Scholar
  30. 30.
    Tavera M, Petroni J, Leon L, Minue E, Casadei D (2012) Reactive haemophagocytic syndrome associated with parvovirus B19 in a kidney-pancreas transplant patient. Nefrologia 32:125–126. Google Scholar
  31. 31.
    Matsubara K, Uchida Y, Wada T, Iwata A, Yura K, Kamimura K, Nigami H, Fukaya T (2011) Parvovirus B19-associated hemophagocytic lymphohistiocytosis in a child with precursor B-cell acute lymphoblastic leukemia under maintenance chemotherapy. J Pediatr Hematol Oncol 33:565–569. CrossRefGoogle Scholar
  32. 32.
    Uike N, Miyamura T, Obama K, Takahira H, Sato H, Kozuru M (1993) Parvovirus B19-associated haemophagocytosis in Evans syndrome: aplastic crisis accompanied by severe thrombocytopenia. Br J Haematol 84:530–532CrossRefGoogle Scholar
  33. 33.
    Shirono K, Tsuda H (1995) Parvovirus B19-associated haemophagocytic syndrome in healthy adults. Br J Haematol 89:923–926CrossRefGoogle Scholar
  34. 34.
    Matsumoto Y, Naniwa D, Banno S, Sugiura Y (1998) The efficacy of therapeutic plasmapheresis for the treatment of fatal hemophagocytic syndrome: two case reports. Ther Apher 2:300–304CrossRefGoogle Scholar
  35. 35.
    Chen JS, Lin KH, Lin DT, Chen RL, Jou ST, Su IJ (1998) Longitudinal observation and outcome of nonfamilial childhood haemophagocytic syndrome receiving etoposide-containing regimens. Br J Haematol 103:756–762CrossRefGoogle Scholar
  36. 36.
    Imashuku S, Hibi S, Ohara T, Iwai A, Sako M, Kato M, Arakawa H, Sotomatsu M, Kataoka S, Asami K, Hasegawa D, Kosaka Y, Sano K, Igarashi N, Maruhashi K, Ichimi R, Kawasaki H, Maeda N, Tanizawa A, Arai K, Abe T, Hisakawa H, Miyashita H, Henter JI (1999) Effective control of Epstein-Barr virus-related hemophagocytic lymphohistiocytosis with immunochemotherapy. Histiocyte Society Blood 93:1869–1874Google Scholar
  37. 37.
    Estlin EJ, Palmer RD, Windebank KP, Lowry MF, Pearson AD (1996) Successful treatment of non-familial haemophagocytic lymphohistiocytosis with interferon and gammaglobulin. Arch Dis Child 75:432–435CrossRefGoogle Scholar
  38. 38.
    Lapphra K, Scheifele D (2011) Can children with minor illnesses be safely immunized? Paediatr Child Health 16:463Google Scholar
  39. 39.
    Grohskopf LA, Sokolow LZ, Broder KR et al (2017) Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices - United States, 2017-18 influenza season. MMWR Recomm Rep 66:1–20Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hsuan-Yun Hu
    • 1
  • Shyh-Yuh Wei
    • 1
    • 2
  • Wei-Hsiang Huang
    • 1
  • Chih-Hsin Pan
    • 1
    Email author
  1. 1.Institute of Forensic MedicineMinistry of JusticeNew Taipei CityTaiwan
  2. 2.Department of Psychiatry, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan

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