American Journal of Therapeutics · 2018 · 11 citations · 6 references
PharmacyImmunologyPharmacotherapyImmunotherapyInflammationTransplant ImmunologyImmunomodulatory Drug TherapyImmunomodulatory DrugsImmunosuppressionImmunosuppression ManagementImmunosuppressive AgentsImmunosuppressive TherapyCombination Immunosuppressive RegimensCombination TherapyImmune Cell Proliferation InhibitionImmunosuppression RegimensImmunosuppressive CompoundsImmunosuppressive Drug TherapyLymphocyte Proliferation InhibitionPost-transplant Immunosuppression
CLINICAL FEATURES: Giant cell myocarditis (GCM) is a rare and a rapidly progressive disorder with fatal outcomes such that patients often require heart transplantation. We present a case of recurrent GCM in a transplanted patient with a history of Crohn disease requiring a novel therapeutic approach. THERAPEUTIC CHALLENGE: After the orthotopic heart transplantation, GCM recurred on aggressive immunosuppression over the months, which included corticosteroids, basiliximab, tacrolimus, antithymocyte globulin, and rituximab. Although combination immunosuppressive therapy containing cyclosporine and 2-4 additional drugs including corticosteroids, azathioprine, mycophenolate mofetil, muromonab, gammaglobulin, or methotrexate have shown to prolong the transplant-free survival by keeping the disease under control, its role in preventing and treating recurrence posttransplantation is unclear. SOLUTION: We added sirolimus, a macrolide antibiotic, with properties of T- and B-lymphocyte proliferation inhibition on the above immunosuppressive treatment postrecurrence of GCM. After sirolimus initiation and continuation, the patient has remained disease free.
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