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23 April 2013 : Case report  Japan

Successive immunosuppressive treatment of fulminant myocarditis that is refractory to mechanical circulatory support

Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Rare disease

Hiroshi NakashimaABCDEF, Yasuhiro UmeyamaBD, Kazutoshi MinamiABCD

DOI: 10.12659/AJCR.889109

Am J Case Rep 2013; 14:116-119

Abstract

Background: Long-term prognosis in patients with fulminant myocarditis can be favorable; however, for 32–36% of patients, this condition becomes fatal during the acute stages despite the use of mechanical circulatory support. Other therapeutic options may be needed for patients in whom these conditions are resistant to aggressive management.
Case Report: We present a case of fulminant myocarditis that rapidly progressed to cardiogenic shock and in-hospital cardiac arrest in a 46-year-old male. The patient promptly received inotropic agents, intra-aortic balloon pump therapy, and extracorporeal membrane oxygenation. However, creatinine kinase (CK), C-reactive protein (CRP), and QRS width increased significantly between days 1 and 3 of treatment; the patient’s hemodynamic profile deteriorated despite this treatment regimen. Intravenous methylprednisolone was initiated on day 3 at a dose of 1,000 mg/day and maintained for an additional three days. Less than 24 h after methylprednisolone administration, the QRS width decreased significantly from 0.44 s to 0.18 s. In addition, CK and CRP levels declined sharply, which is associated with hemodynamic improvement.
Conclusions: High doses of intravenous methylprednisolone may be considered a therapeutic option for patients with fulminant myocarditis that is refractory to usual management practices.

Keywords: myocarditis, Extracorporeal Membrane Oxygenation, Extracorporeal Membrane Oxygenation, Immunosuppression

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923