Mumps virus and endocardial fibroelastosis

The Journal of P E D I A T R I C S

681

Letters to the Editor

Mumps virus and endocardial fibroelastosis

To the Editor: We read with great interest your short article oft "Positive skin reactivity to mumps virus antigen in endocardial fibroelastosis," by George R. Noren, M.D., Paul Adams, Jr., M.D., and Ray C. Anderson, M.D. (J. Pediat. 62: 604, 1963). There are a number of points that arise out of this publication that require clarification. Before associating infection with the mumps virus during the first trimester of pregnancy in the etiology of some cases of endocardial tibroelastosis, it would be important to know the following: 1. That the diagnosis has been confirmed by autopsy in a substantial number of patients. The only patient in this series with proved E F E had aortic stenosis. Under the circumstances, the PndocardiM fihroela~tnsis was almost certain!v secondary to the stenosis and, therefore, not primary. 2. It would be important to determine whether the mothers of infants with positive skin tests also had positive skin tests.

3. A control injection to determine whether sensitivity is actually due to mumps antigen, or to a constituent of the antigen solution, is essential. Furthermore, there was only one mother who actually had mumps during the first month of pregnancy and 5 out of 9 denied any exposure to this illness. For us the data suggest an apparent lack of correlation between mumps in the first trimester of pregnancy and endocardial fibroelastosis and raises the question as to whether the immune mechanism may perhaps be altered in such a way in patients with EFE as to give rise to a positive skin test without exposure to to mumps during the period of gestation. JOSHUA

LYNF1ELD~

SUMNER IIr

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STATE UNIVERSITY 450

M.D.

BERKOVICH~

CI,ARKSON

BROOKLYN

M.D,

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OF N E W

yORK

AVFNI_IF

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Reply To the Editor: We are happy to comment on tile questions raised by Drs. Lynfield and Berkovich, especially since this affords us an opportunity to add some additional clinical information. In regard to their specific questions : 1. We have no additional autopsy information on our cases. This will take several years, and possibly will necessitate the pooling of data from various centers in order to achieve significant numbers. As to the infant with aortic stenosis on w h o m we have autopsy data, our pathologist considers the endocardial fibroelastosis to be primary. He considered the find-

ings to be considerably different from those of secondary endocardial fibroelastosis. Moreover, we are of the opinion that "primary endocardial fibroelastosis" not uncommonly involves the mitral and aortic valves, and that aortic stenosis may indeed be clinically and pathologically evident in this condition. Interestingly, we have had two infants with negative mumps skin tests; one dying of glycogen storage disease and the other with aortic stenosis, with the usual appearance at autopsy of secondary endocardial fibroelastosis. We think that the mumps skin test may well prove to be helpful in separating primary from secondary endocardial fibroelastosis, al-