title: Successful high-dose intravenous immunoglobulin therapy for a patient with fulminant myocarditis.
abstract: A 45-year-old man developed fulminant myocarditis for which ventricular assist devices (intra-aortic balloon pumping and percutaneous cardiopulmonary support) were required for hemodynamic support. Echocardiography showed left ventricular akinesis and, since no improvement was noted on the following day, immunoglobulin (70 g/day for 2 days) was added to the therapy. The left ventricular ejection fraction increased to 25% and 40% at 12 and 36 h, respectively, representing a marked improvement in wall motion within a very short period. An endomyocardial biopsy specimen revealed focal lymphomononuclear infiltrate with adjacent myocytolysis, and acute lymphocytic myocarditis was diagnosed. Two days after administration of immunoglobulin, the serum level of interleukin-6 decreased rapidly from 180 to 5.9 pg/ml. In this patient, cardiac function improved immediately after immunoglobulin administration, suggesting the usefulness of this therapy. Three years after the diagnosis the patient is in good health, with steady normal left ventricular ejection fraction. We conclude that there are cases of acute myocarditis in which high-dose intravenous immunoglobulin therapy is effective.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kato
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Morimoto
authors.forename: Shinya
authors.initials: S
authors.lastname: Hiramitsu
authors.forename: Akihisa
authors.initials: A
authors.lastname: Uemura
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Ohtsuki
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Kato
authors.forename: Kenji
authors.initials: K
authors.lastname: Miyagishima
authors.forename: Nami
authors.initials: N
authors.lastname: Mori
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hishida
mesh_terms: D004699:Endocardium / Q000473:pathology; D006353:Heart-Assist Devices; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D012770:Shock, Cardiogenic / Q000628:therapy; D013318:Stroke Volume
chemical_list: D016756:Immunoglobulins, Intravenous