[Off-label use of intravenous immunoglobulin therapy in the treatment of lupus myocarditis: Two case reports and literature review].
BACKGROUND
Several case reports have reported the benefit of intravenous immunoglobulin therapy in many autoimmune diseases, including systemic lupus erythematosus.


METHODS
Here, we report on two cases of lupus myocarditis treated with high dose of intravenous immunoglobulin. The first patient was a 42-year-old woman who presented with lupus myocarditis that was resistant to corticosteroids and cyclophosphamide, and who was finally successfully treated with a single dose of 2 g/kg of intravenous immunoglobulin. The patient displayed clinical improvement a few days later. The second case - a 43-year-old woman was diagnosed with lupus myocarditis and immunosuppressive drugs were contraindicated because of the context of a recent infective endocarditis. She was treated with repeated dose of 2 g/kg of intravenous immunoglobulin. Clinical improvement was observed and the left ventricular ejection fraction increased from 20 % to 60 % within a few days. We also report 9 similar observations identified from a literature review.


CONCLUSIONS
The use of intravenous immunoglobulin in lupus myocarditis is not officially recognized but could be considered as an alternative when conventional therapies have failed or are contraindicated.
Service pharmaceutique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France. Electronic address: nicolas.charhon@chu-lyon.fr.
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Charhon
Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
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Bernard
Service de réanimation médicale et d'assistance respiratoire, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
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Richard
Unité de dermatologie-médecine interne, CHU Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, France; EA 4546, université des Antilles, campus de Fouillole, BP 250, 97157 Pointe-à-Pitre, Guadeloupe.
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Cordel
Service pharmaceutique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
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Leboucher
Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
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Broussolle
Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
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Sève
D000328:Adult; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000628:therapy*; D009205:Myocarditis / Q000209:etiology / Q000628:therapy*; D056687:Off-Label Use; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous
Immunoglobulines intraveineuses; Intravenous immunoglobulins; Lupus; Myocardite; Myocarditis; Off-label use; Systemic lupus erythematosus; Thérapeutiques hors AMM