title: Polymyositis and myocarditis after donor lymphocyte infusion.
abstract: Chronic graft versus host disease (GVHD) is a common late complication of hematopoietic stem cell transplantation. Polymyositis is a rare manifestation of chronic GVHD after donor lymphocyte infusion (DLI). Patients with both polymyositis and myocarditis have not been reported to date. Here, we report an 18-year-old female patient who developed polymyositis and myocarditis after a DLI. The patient developed the symptoms of fever, generalized myalgia, dysarthria, and asymptomatic sinus tachycardia at DLI day +102, and 17 days after the discontinuation of immunosuppressants. The laboratory testing showed elevated muscle enzymes, and the electromyographic examination revealed myopathic abnormalities compatible with the diagnosis of myositis. The muscle biopsy showed CD8+ T cell infiltration of the muscle fibers. The electrocardiogram (ECG) showed sinus tachycardia with an incomplete right bundle branch block, anteroseptal ST elevation and lateral ST depression. Echocardiography showed mild hypokinesia of the left interventricular septal wall without evidence of infection or leukemic relapse. The patient was immediately treated with 60 mg/day of prednisone and tacrolimus after the diagnosis of polymyositis and myocarditis, apparently associated with chronic GVHD. The cardiac and muscle enzymes decreased and the ECG normalized after immunosuppressant treatment. The follow-up ECG 2 weeks after initiation of therapy was normal.
authors.affiliation: Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
authors.forename: Jae-Sook
authors.initials: JS
authors.lastname: Ahn
authors.affiliation: Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Cho
authors.affiliation: Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
authors.forename: Yeo-Kyeoung
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
authors.forename: Deok-Hwan
authors.initials: DH
authors.lastname: Yang
authors.affiliation: Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
authors.forename: Woo Kyun
authors.initials: WK
authors.lastname: Bae
authors.affiliation: Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Shim
authors.affiliation: Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
authors.forename: Je-Jung
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
authors.forename: Ik-Joo
authors.initials: IJ
authors.lastname: Chung
authors.affiliation: Department of Pathology, Chonnam National University Hospital, 671, Jebongno, Donggu, Gwangju, 501-757, South Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Juhng
authors.affiliation: Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea. hjoonk@chonnam.ac.kr.
authors.forename: Hyeoung-Joon
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001782:Blood Donors; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007938:Leukemia / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D017710:Lymphocyte Transfusion; D009205:Myocarditis / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D017285:Polymyositis / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D011241:Prednisone / Q000008:administration & dosage; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D011241:Prednisone; D016559:Tacrolimus