Rapid resolution of severe myocardial dysfunction in a patient with rheumatoid arthritis by intravenous immunoglobulin and steroid treatment

Chin Yu Lin, Chien Yi Hsu, Po Hsun Huang

Research output: Contribution to journalArticle

Abstract

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) from10% 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.

Original languageEnglish
Pages (from-to)570-573
Number of pages4
JournalActa Cardiologica Sinica
Volume30
Issue number6
DOIs
Publication statusPublished - Nov 9 2014
Externally publishedYes

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Keywords

  • Fulminant myocarditis
  • Intravenous immunoglobulin
  • Rheumatoid arthritis
  • Systemic steroid

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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