title: Fatal acute necrotizing eosinophilic myocarditis temporally related to use of adalimumab in a patient with relapsing polychondritis.
abstract: Tumor necrosis factor α (TNF-α) antagonists are being increasingly used as maintenance therapies for rheumatic diseases, and therefore knowledge of their adverse effects is important. We report a case of fatal acute necrotizing eosinophilic myocarditis temporally related to use of a second course of the TNF-α antagonist, adalimumab. A 51-year-old woman with relapsing polychondritis took adalimumab 2 weeks before presenting with acute myocarditis. Within hours of presentation to the emergency department, she had cardiac arrest due to fulminant heart failure. Autopsy demonstrated necrotizing eosinophilic myocarditis. This is a rare cause of fulminant heart failure. This is the first report of a TNF-α antagonist potentially associated with acute necrotizing eosinophilic myocarditis.
authors.affiliation: From the *Division of Pulmonary & Critical Care Medicine, University ofWashington School of Medicine, Seattle, WA; and †Department of Rheumatology and ‡Division of Cardiology, New York University; §Division of Rheumatology, Department of Medicine, St Luke's Roosevelt Hospital Center; and ∥Division of Pulmonary, Critical Care & Sleep Medicine, New York University, New York, NY.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Adamson
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yazici
authors.forename: Edward S
authors.initials: ES
authors.lastname: Katz
authors.forename: Stewart G
authors.initials: SG
authors.lastname: Greisman
authors.forename: David
authors.initials: D
authors.lastname: Steiger
mesh_terms: D000208:Acute Disease; D000068879:Adalimumab; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001344:Autopsy; D015897:Comorbidity; D004802:Eosinophilia / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D009205:Myocarditis / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D011081:Polychondritis, Relapsing / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab