Publication: Successful intravenous immunoglobulin therapy in a case of acute fulminant myocarditis
Abstract
Fulminan miyokardit, miyokardı tutan ve ani başlangıçlı akut kalp yetersizliğine neden olan enflamatuvar bir hastalıktır. Hastalar hızlı ve agresif tedavi edilmezlerse prognoz kötüdür. Miyokardit gelişiminde otoimmün mekanizmaların rolü olduğu düşünülse de, miyokarditte immündüzenleyici tedaviler halen araştırma konusudur. Bu yazıda, standart medikal tedaviye rağmen klinik durumu hızla bozulma gösteren, akut miyokarditli 30 yaşında bir kadın hasta sunuldu. Hastaya yüksek doz intravenöz immünglobulin tedavisi (2 günde 70 gr/gün) uygulandı ve tedavinin ikinci gününde klinik tablosunda belirgin iyileşme görüldü. Sol ventrikül ejeksiyon fraksiyonu %32’den tedavinin 24. saatinde %40’a, 48. saatinde %50’ye yükseldi. Hasta 10. günde normal ejeksiyon fraksiyonu ile taburcu edildi ve iki yıllık takip süresince yeni kardiyak olay gelişmedi. Yüksek doz intravenöz immünglobulin tedavisi seçilmiş hastalarda, özellikle akut fulminan miyokarditin erken döneminde yararlı olabilir.
Fulminant myocarditis is an inflammatory process that occurs in the myocardium and causes acute-onset heart failure. Its prognosis is poor unless patients are promptly and aggressively supported. Although an autoimmune mechanism has been postulated for myocarditis, immunomodulatory treatment strategies are still under investigation. We report on a 30-year-old woman with acute myocarditis, whose condition rapidly deteriorated despite standard medical therapy. High-dose intravenous immunoglobulin therapy (70 g/day for 2 days) was given and the patient showed dramatic improvement on the second day. Left ventricular ejection fraction increased from 32% to 40% and to 50% at 24 and 48 hours of treatment, respectively. She was discharged on the tenth day with normal ejection fraction. She was free of cardiac events during a two-year follow-up. High-dose intravenous immunoglobulin may be potentially useful in selected patients, especially if given early in acute fulminant myocarditis.
Fulminant myocarditis is an inflammatory process that occurs in the myocardium and causes acute-onset heart failure. Its prognosis is poor unless patients are promptly and aggressively supported. Although an autoimmune mechanism has been postulated for myocarditis, immunomodulatory treatment strategies are still under investigation. We report on a 30-year-old woman with acute myocarditis, whose condition rapidly deteriorated despite standard medical therapy. High-dose intravenous immunoglobulin therapy (70 g/day for 2 days) was given and the patient showed dramatic improvement on the second day. Left ventricular ejection fraction increased from 32% to 40% and to 50% at 24 and 48 hours of treatment, respectively. She was discharged on the tenth day with normal ejection fraction. She was free of cardiac events during a two-year follow-up. High-dose intravenous immunoglobulin may be potentially useful in selected patients, especially if given early in acute fulminant myocarditis.