Use of OKT3 for acute myocarditis in infants and children.
Acute viral myocarditis triggers an autoimmune phenomenon that aggressive immunosuppressive therapy with monoclonal OKT3 may suppress. We treated 5 patients, aged 15 months to 16.5 years, who had acute viral myocarditis and left ventricular ejection fraction (LVEF) of 5% to 20%, with a combination immunosuppressive regimen that included OKT3, intravenous immunoglobulin, methylprednisone, cyclosporine, and azathioprine. Within 2 weeks of therapy, all patients demonstrated normalization of LVEF to 50% to 74%, and on mid-term follow-up, we have found no recurrence of heart failure or progression to dilated cardiomyopathy. In patients with severe acute myocarditis, aggressive immunosuppressive regimen based on OKT3 is safe and may inhibit or reverse the immune response, resulting in dramatic improvement in myocardial function.
Ahdoot
J
J
Division of Pediatric Cardiology, UCLA School of Medicine, Los Angeles, California, USA.
Galindo
A
A
Alejos
J C
JC
George
B
B
Burch
C
C
Marelli
D
D
Sadeghi
A
A
Laks
H
H
D000208:Acute Disease; D000293:Adolescent; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D016853:Muromonab-CD3 / Q000009:adverse effects / Q000627:therapeutic use*; D009205:Myocarditis / Q000175:diagnosis / Q000188:drug therapy*; D016277:Ventricular Function, Left / Q000187:drug effects; D014777:Virus Diseases / Q000175:diagnosis / Q000188:drug therapy*
D007166:Immunosuppressive Agents; D016853:Muromonab-CD3