Polymyositis and myocarditis after donor lymphocyte infusion.
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.
Ahn
Jae-Sook
JS
Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
Cho
Sang-Hee
SH
Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
Kim
Yeo-Kyeoung
YK
Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
Yang
Deok-Hwan
DH
Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
Bae
Woo Kyun
WK
Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
Shim
Hyun Jeong
HJ
Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
Lee
Je-Jung
JJ
Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
Chung
Ik-Joo
IJ
Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea.
Juhng
Sang Woo
SW
Department of Pathology, Chonnam National University Hospital, 671, Jebongno, Donggu, Gwangju, 501-757, South Korea.
Kim
Hyeoung-Joon
HJ
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.
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
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D011241:Prednisone; D016559:Tacrolimus