Acute heart failure due to dilated cardiomyopathy exacerbated by systemic parechovirus-A1 infection in an infant.

Parechovirus-A1 (PeV-A1) often causes mild respiratory or gastrointestinal disease. Herein we report a case of acute heart failure due to dilated cardiomyopathy (DCM) exacerbated by acute PeV-A1 infection in a 10-month-old infant. He presented to our hospital with acute respiratory distress and compensated shock. Echocardiogram showed a dilated left ventricle and severe mitral regurgitation, consistent with DCM. PeV-A1 infection was confirmed by 1) positive PCR for PeV-A in multiple anatomical sites including blood, stool, and throat swab samples, 2) genetic sequence of viral protein, and 3) an increase in paired serum PeV-A1-specific neutralizing antibody titers. A few, scattered case reports in infants and young children also indicate the association between myocarditis and/or DCM and PeV-A1 infection. In conclusion, PeV-A1 infection could be associated with exacerbation of myocardial diseases in infants and young children; thus PeV-A1 needs to be evaluated as a viral cause of such condition.