Acute Chest Syndrome (ACS) continues to be a major source of morbidity and mortality among patients with sickle cell disease. It is characterized by the presence of pleutitic chest pain, fever, raies on lung auscultation, and pulmonary infiltrates on chest X-ray [Castro et ai: Blood 84:643-649, 19941. The pathophysiology of this disorder remains poorly understood leading to the descriptive term "Acute Chest Syndrome" designated by Charache et at. [Arch ht8m Med 139:67-69, 19791. Typical bacterial pathogens are seldom isolated in adults, although they play a significant role in the pathogenesis of this entity in children. Until recently, the technology to accurately study viral infection as a precipitating cause of ACS has been unavailable.
Parvovirus B19 is being increasingly recognized as an important human pathogen, and has been established as the cause of transient "apiastic crisis" in patients with sickle cell disease [Saarlen et ai: B/ood67:11411-11417,1986; Young: Sem Hemeto/25:159-172, 19881. We present three patients with hemoglobin SC variant of sickle cell disease who developed ACS in association with acute parvovirus B19 infection, one of which died of respiratory failure. Parvovirus B19 infection was established by polymerase chain reaction for parvovirus B19 DNA, and the presence of parvovirus B19 specific igM antibodies. These cases suggest that parvovirus B19 may be associated with more than self-limited illness in patients with sickle cell disease, and that this ubiquitous virus may merit further study as a precipitating cause of ACS.