Key result
Biopsy-guided immunosuppression upgrade effectively treated autoimmune myocarditis in a patient with mixed connective tissue disease, resulting in complete recovery of left ventricular ejection fraction to 59%.
Case Report (n=1)
No
Endomyocardial biopsy is crucial in patients with systemic immune-mediated diseases to differentiate between infectious and autoimmune myocarditis and guide appropriate immunosuppressive therapy.
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May support biopsy-guided immunosuppression in autoimmune myocarditis with connective tissue disease; hypothesis-generating, requiring prospective validation.
A 56-year-old woman with mixed connective tissue disease, who was on maintenance immunosuppression, developed asymptomatic left ventricular dysfunction, ventricular arrhythmia, and high troponin I. Heart catheterization showed normal coronaries and biopsy-proven, virus-negative lymphocytic myocarditis. A biopsy-guided immunosuppression upgrade effectively treated autoimmune myocarditis, which resulted in ventricular function recovery, resolution of arrhythmia, and of troponin release. (Level of Difficulty: Advanced.)
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Figliozzi et al. (2019) conducted a case report in Mixed Connective Tissue Disease with autoimmune myocarditis (n=1). Immunosuppressive therapy (prednisone and mycophenolate mofetil) was evaluated on Left ventricular ejection fraction (LVEF) recovery. Biopsy-guided immunosuppression upgrade effectively treated autoimmune myocarditis in a patient with mixed connective tissue disease, resulting in complete recovery of left ventricular ejection fraction to 59%.
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