High-dose intravenous immunoglobulin in the treatment of acute myocarditis. A case report and review of the literature.
A few reports have suggested the beneficial effect of high-dose intravenous immunoglobulin (IVIG) in the treatment of acute myocarditis and cardiomyopathy. We describe a 49-year-old woman in which acute myocarditis was diagnosed on the basis of clinical and echocardiographic findings. Conventional treatment with captopril and frusemide was administered: intravenous heparin and, subsequently, oral anticoagulants were added because of the appearance of an apical thrombus. On the fifth day of hospitalization, treatment with high-dose (400 mg kg(-1) day(-1)) IVIG was started and prosecuted for 5 days. A dramatic improvement of clinical conditions was observed, with increase of the left ventricular ejection fraction (LVEF) from 30% to 75% within 1 week. One year after the diagnosis the patient is in good health, with steady normal LVEF. The rapid recovery, which was immediately subsequent to the administration of high-dose IVIG, suggests that this kind of treatment has been effective in our patient with acute myocarditis.
Tedeschi
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First Division of Internal Medicine, IRCCS Ospedale Maggiore Policlinico, Milan, Italy. aval.ted@tin.it
Airaghi
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Giannini
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Ciceri
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Massari
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FM
D000208:Acute Disease; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D007116:Immunization, Passive; D008875:Middle Aged; D009205:Myocarditis / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects