High‐dose intravenous immunoglobulin in the treatment of acute myocarditis. A case report and review of the literature

Abstract. Tedeschi A, Airaghi L, Giannini S, Ciceri L, Massari FM (IRCCS Ospedale Maggiore Policlinico, Milan, Italy). High‐dose intravenous immunoglobulin in the treatment of acute myocarditis. A case report and review of the Literature. J Intern Med 2002; 251 : 169–173. A few reports have suggested the beneficial effect of high‐dose intravenous immunoglobulin (IVIG) in the treatment of acute myocarditis and cardiomyopathy. We describe a 49‐year‐old woman in which acute myocarditis was diagnosed on the basis of clinical and echocardiographic findings. Conventional treatment with captopril and frusemide was administered; intravenous heparin and, subsequently, oral anticoagulants were added because of the appearance of an apical thrombus. On the fifth day of hospitalization, treatment with high‐dose (400 mg kg −1 day −1 ) IVIG was started and prosecuted for 5 days. A dramatic improvement of clinical conditions was observed, with increase of the left ventricular ejection fraction (LVEF) from 30% to 75% within 1 week. One year after the diagnosis the patient is in good health, with steady normal LVEF. The rapid recovery, which was immediately subsequent to the administration of high‐dose IVIG, suggests that this kind of treatment has been effective in our patient with acute myocarditis.