Plasma concentrations of cytokines and neurohumoral factors in a case of fulminant myocarditis successfully treated with intravenous immunoglobulin and percutaneous cardiopulmonary support.
A 53-year-old Japanese man with fulminant myocarditis was referred. Percutaneous cardiopulmonary support (PCPS) was introduced immediately and intravenous immunoglobulin (IVIG) therapy followed for 2 days. Cardiac function showed signs of recovery on the 4th hospital day and the patient was weaned from PCPS on the 7th hospital day. Creatine kinase-MB peaked at 12 h after admission and was 176 ng/ml. Endomyocardial biopsy showed active myocarditis. A marked increase of the neutralizing antibody titer suggested coxsackievirus B3 infection. Plasma concentrations of cytokines and neurohumoral factors were analyzed. Proinflammatory cytokines, such as interleukin (IL)-1beta, IL-6 and tumor necrosis factor (TNF-alpha), and anti-inflammatory cytokines, such as IL-1 receptor antagonist, soluble TNF receptor-1 and IL-10, were elevated on admission and all had decreased on the 7th hospital day. Brain natriuretic peptide and noradrenaline were already elevated upon admission (1,940 pg/ml and 4.6 ng/ml, respectively) and decreased thereafter. Although IVIG therapy under PCPS is a common treatment for fulminant myocarditis, the immunological response in vivo remains unclear. This case demonstrated suppression of serum cytokines after IVIG and PCPS treatment. Immunological parameters in those who have been treated with IVIG and PCPS and survived without complications are of great value for evaluation of the therapy. Further analysis with more cases in a multicenter study is necessary.
Abe
Satoru
S
Division of Cardiology, Hematology and Endocrinology/Metabolism, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi, Niigata, Japan.
Okura
Yuji
Y
Hoyano
Makoto
M
Kazama
Ryu
R
Watanabe
Satoru
S
Ozawa
Takuya
T
Saigawa
Takashi
T
Hayashi
Manabu
M
Yoshida
Tsuyoshi
T
Tachikawa
Hitoshi
H
Kashimura
Takeshi
T
Suzuki
Keisuke
K
Nagahashi
Masayuki
M
Watanabe
Junzo
J
Shimada
Kouji
K
Hasegawa
Go
G
Kato
Kiminori
K
Hanawa
Haruo
H
Kodama
Makoto
M
Aizawa
Yoshifusa
Y
D002309:Cardiology / Q000379:methods; D003384:Coxsackievirus Infections / Q000097:blood / Q000628:therapy; D003402:Creatine Kinase / Q000097:blood; D016207:Cytokines / Q000097:blood*; D006321:Heart / Q000503:physiopathology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000097:blood* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy* / Q000821:virology; D009206:Myocardium / Q000473:pathology; D018377:Neurotransmitter Agents / Q000097:blood*; D009994:Osmolar Concentration; D013997:Time Factors
D016207:Cytokines; D016756:Immunoglobulins, Intravenous; D018377:Neurotransmitter Agents; D003402:Creatine Kinase