Rapid Resolution of Severe Myocardial Dysfunction in a Patient with Rheumatoid Arthritis by Intravenous Immunoglobulin and Steroid Treatment.
A 64-year-old man with rheumatoid arthritis (RA) presented to our emergency department with severe chest tightness and dyspnea. His electrocardiography (ECG) showed multiple premature atrial complexes (PACs) with wide QRS, and transthoracic echocardiography revealed severe hypokinesis of the left ventricle. The patient later developed sudden cardiovascular collapse with presumed fulminant myocarditis and cardiogenic shock. Further investigation showed that coronary angiogram, viral studies and autoimmune vasculitis markers were all negative. After high-dose intravenous immunoglobulin (IVIG) and systemic steroid were administered, a dramatic improvement of clinical conditions was observed, with an increase of the left ventricular ejection fraction (LVEF) from 10% to 42% within one week, and a resolution of the wide QRS on the ECG. The rapid recovery from left ventricular dysfunction by treatment with IVIG and systemic steroid suggests immunotherapy might be effective in RA patients with acute fulminant myocarditis.


BACKGROUND
Fulminant myocarditis; Intravenous immunoglobulin; Rheumatoid arthritis; Systemic steroid.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Cardiovascular Research Center;
Chin-Yu
CY
Lin
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Cardiovascular Research Center;
Chien-Yi
CY
Hsu
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Cardiovascular Research Center; ; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Po-Hsun
PH
Huang