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.
Division of Cardiovascular Diseases, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA. murphy.joseph@mayo.edu
Joseph G
JG
Murphy
R Scott
RS
Wright
G Keith
GK
Bruce
Larry M
LM
Baddour
Michael A
MA
Farrell
William D
WD
Edwards
Hirohito
H
Kita
Leslie T
LT
Cooper
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