title: Fulminant acute cellular rejection with negative findings on endomyocardial biopsy.
abstract: We present a case of a heart transplant recipient who had new-onset heart failure, repeatedly unremarkable endomyocardial biopsies, a negative evaluation for humoral rejection, and subsequently autopsy findings of severe sub-epicardial myocyte necrosis with classic cellular rejection. The sub-endocardial layer was free from rejection. The implications for clinical management, in the context of a diagnosis of "biopsy-negative rejection with hemodynamic compromise," include the need to consider intensification of immunosuppression with regimens similar to those used for biopsy-proven rejection.
authors.affiliation: Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Rajeshkumar
authors.initials: R
authors.lastname: Bhalodolia
authors.forename: Cherise
authors.initials: C
authors.lastname: Cortese
authors.forename: Michael
authors.initials: M
authors.lastname: Graham
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hauptman
mesh_terms: D000208:Acute Disease; D001706:Biopsy; D005188:False Negative Reactions; D017809:Fatal Outcome; D006084:Graft Rejection / Q000473:pathology*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*