Cardiogenic shock due to cytomegalovirus myocarditis: successful clinical treatment.
OBJECTIVE
Cytomegalovirus (CMV) systemic disease and myocarditis in healthy persons is infrequently reported in the literature, although in increasing numbers in recent years. The importance of the recognition of the syndrome that usually has an initial picture of a mononucleosis like infection in an otherwise healthy person, is the available therapeutic agent, ganciclovir, that can cure the infectious disease.


METHODS
We analyzed the clinical result of pulsotherapy with steroids in a patient with CMV myocarditis after 7 days of etiological treatment, with ganciclovir, intravenous vasodilators, and the conventional treatment for congestive heart failure.


RESULTS
The clinical condition of the patient improved accordingly to the better function of the left ventricle, and the ganciclovir was kept for 21 days, most of it in an out patient basis. The patient was dismissed from the hospital, with normal myocardial function.


CONCLUSIONS
Potentially curable forms of myocarditis, like M pneumoniae and CMV, for example, can have an initial disproportionate aggression to the myocardium, by the acute inflammatory reaction, that can by itself make worse the damage to the LV function. In our opinion, the blockade of this process by pulsotherapy with steroids can help in the treatment of these patients. We understand that the different scenario of immunosuppressive treatments for the possible auto immunity of the more chronic forms of the presumably post viral cardiomyopathy has been in dispute in the literature, and has stolen the focus from the truly acute cases.
Baumgratz
José Francisco
JF
drvila@terra.com.br
Vila
José Henrique Andrade
JH
Silva
José Pedro da
JP
Fonseca
Luciana da
Ld
Rodrigues
Edwal A Campos
EA
Knobel
Elias
E
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D015774:Ganciclovir / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D009205:Myocarditis / Q000188:drug therapy* / Q000821:virology; D011241:Prednisone / Q000627:therapeutic use; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000209:etiology; D017334:Teicoplanin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000959:Antihypertensive Agents; D000998:Antiviral Agents; D005938:Glucocorticoids; D017334:Teicoplanin; D015774:Ganciclovir; D011241:Prednisone