Anakinra led to rapid clinical improvement in a patient with fulminant viral myocarditis, allowing weaning from ECMO and LVAD within 4 days and excellent health at 12 months.
Case Report (n=1)
Does anakinra improve cardiac function in a patient with fulminant viral myocarditis and cardiogenic shock?
Interleukin-1 blockade with anakinra may be a promising treatment for fulminant viral myocarditis with cardiogenic shock, allowing weaning from mechanical circulatory support.
OBJECTIVE: Treatment of viral fulminant myocarditis relies on life support measures. Based on studies pointing to a role for the proinflammatory cytokine interleukin-1 in myocardial inflammation and contractile dysfunction, we treated a patient with fulminant viral myocarditis with the interleukin-1 receptor blocking agent anakinra. We report the response and discuss the biologic rationale of this novel treatment approach. DESIGN: Case report. SETTING: ICU. PATIENT: A 36-year-old woman who was hospitalized for fulminant myocarditis with biventricular failure and cardiogenic shock, acutely manifested with hypotension and dyspnea. INTERVENTIONS: Following the progressive, life-threatening collapse of the cardiac function in spite of treatment with venous-arterial extracorporeal membrane oxygenation and mechanical circulatory support with a left ventricular assist device, treatment with the interleukin-1 receptor blocking agent anakinra 100 mg/d was started. MEASUREMENTS AND MAIN RESULTS: The severe depression of cardiac function responded promptly to interleukin-1 inhibition. Within 4 days of treatment initiation, progressive clinical improvement allowed weaning from extracorporeal membrane oxygenation and removal of the percutaneous left ventricular assist device. The patient was discharged home and remains in excellent health at 12 months. CONCLUSIONS: Clinical and experimental evidence suggests that interleukin-1 blockade is effective against myocardial inflammation and contractile dysfunction, thus representing a promising candidate for the treatment of inflammatory heart failure. Although further confirmation is needed, these encouraging results indicate that anakinra may be a suitable treatment for fulminant myocarditis.
Cavalli et al. (Tue,) conducted a case report in Fulminant viral myocarditis (n=1). Anakinra was evaluated on Clinical improvement and recovery of cardiac function. Anakinra led to rapid clinical improvement in a patient with fulminant viral myocarditis, allowing weaning from ECMO and LVAD within 4 days and excellent health at 12 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: