Cytomegalovirus myocarditis in a healthy infant: Complete recovery after ganciclovir treatment.

Abstract

OBJECTIVES: To report a case of acute myocarditis caused by cytomegalovirus infection in a 15-month-old immunocompetent infant completely recovered with ganciclovir treatment. DESIGN: Descriptive case report. SETTING: Pediatric intensive care unit in a general hospital. Patient: A 15-month-old healthy girl with acute, severe myocarditis. INTERVENTION: General supportive intensive care and mechanical ventilatory support, iv immunoglobulin, and iv ganciclovir. MEASUREMENTS AND MAIN RESULTS: Intensive supportive care including iv fluids, mechanical ventilatory support, diuretics (furosemide, spironolactone), digoxin, dobutamine, captopril, methylprednisolone, and iv immunoglobulin. Despite clinical stabilization, shortening fraction remained very poor at 17%. Addition of iv ganciclovir resulted in prompt and complete recovery of the cardiac muscle contractility with a shortening fraction of 35% that remained normal during a long follow-up period. CONCLUSIONS: Cytomegalovirus should be considered as a causative agent in acute myocarditis even in the normal, immunocompetent host. In such cases, addition of ganciclovir treatment should be strongly considered.