A 33-year-old male patient was admitted to our hospital with fever, diarrhoea, and symptoms of cardiogenic shock after cross-country running. Laboratory data showed an lactate of 4.5 mmol/L, increased troponin t (18 557 ng/L), and creatine phosphokinase levels of 4404 U/I. Coronary angiography demonstrated normal coronary arteries with no electrolytic disturbances. Cardiac index of 1.2 L/min/m², mean arterial pressure of 45 mmHg, a pulmonary artery pulsatility index of 0.7, and a pulmonary capillary wedge pressure of 0.8 were additionally indicating a beginning right heart failure. Transthoracic echocardiography revealed right and left ventricular dysfunction with an ejection fraction of <5% and marked oedema of the left ventricular wall (Panel A, Supplementary material onlineSupplementary material online, Movies). A veno-arterial extracorporeal membrane oxygenation was used as bridging for the biventricular failure, before an orthotopical heart transplant was promptly performed. A viral infection by parvovirus B19 was serologically confirmed. The explanted heart tissue (Panel B) was analysed by scanning electron microscopy (SEM) (Panel C) and serial section SEM (Panel D). Electron microscopy showed a pronounced muscular oedema (Panels B and C, Supplementary material onlineSupplementary material online, Images) with a severely disturbed, partly feathered course of heart muscle fibres (Panel D), and extensive inflammatory infiltrates of lymphocytes (Panel E, red arrowheads).

中文翻译：

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细小病毒B19诱导的暴发性心肌炎中的血管生成。

一名33岁的男性患者因越野跑步后因发烧，腹泻和心源性休克症状而入院。实验室数据显示乳酸为4.5 mmol / L，肌钙蛋白t（18 557 ng / L）增加，肌酸磷酸激酶水平为4404 U / I。冠状动脉造影显示冠状动脉正常，无电解干扰。心脏指数为1.2 L / min / m ²，平均动脉压为45 mmHg，肺动脉搏动指数为0.7，肺毛细血管楔形压力为0.8，这也预示着右心衰竭的开始。经胸超声心动图显示右心室和左心室功能不全，射血分数<5％，左心室壁明显水肿（图A，在线补充材料在线，电影）。在迅速进行原位心脏移植之前，使用静脉-动脉体外膜氧合作为双室衰竭的桥梁。血清学证实细小病毒B19感染了病毒。通过扫描电子显微镜（SEM）（图C）和连续切片SEM（图D）分析移植的心脏组织（图B）。