Eosinophilic-lymphocytic myocarditis after smallpox vaccination.
Smallpox is an eradicated viral disease that has re-emerged as a potential bioterrorism threat. Smallpox vaccination was historically the most effective defence measure against wild smallpox virus. The risk of myopericarditis after vaccination might limit this option. We report a case of biopsy-proven eosinophilic-lymphocytic myocarditis diagnosed in vivo with histological evidence for eosinophil-mediated cardiac myocyte necrosis shortly after smallpox vaccination. Furthermore, we report a beneficial haemodynamic response to high-dose corticosteroids. A better understanding of the aberrant immune mechanism of myocyte injury after smallpox vaccination might improve the risk/benefit assessment for people considering smallpox vaccination and better smallpox vaccines in the future.
Murphy
Joseph G
JG
Division of Cardiovascular Diseases, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA. murphy.joseph@mayo.edu
Wright
R Scott
RS
Bruce
G Keith
GK
Baddour
Larry M
LM
Farrell
Michael A
MA
Edwards
William D
WD
Kita
Hirohito
H
Cooper
Leslie T
LT
D000328:Adult; D018414:CD8-Positive T-Lymphocytes / Q000473:pathology; D004804:Eosinophils / Q000473:pathology; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology*; D009206:Myocardium / Q000473:pathology; D012900:Smallpox Vaccine / Q000009:adverse effects*; D016176:T-Lymphocyte Subsets / Q000473:pathology; D014611:Vaccination / Q000009:adverse effects*
D012900:Smallpox Vaccine