Severe Reversible Global and Regional Ventricular Dysfunction Associated with High-Dose Interleukin-2 Immunotherapy

Bois, Jon S. Du; Udelson, James E.; Atkins, Melany

doi:10.1097/00002371-199508000-00006

Cited by 20 publications

(9 citation statements)

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“…However, we found no report in the literature on stunned myocardium related to acute myocarditis, which would be perfectly acceptable from the pathophysiologic point of view. Du Bois et al 6 reported a similar case induced by the use of interleukin-2 in the treatment of neoplasia.…”

Section: Discussionmentioning

confidence: 92%

Pseudo-myocardial infarction during an episode of herpes zoster

Franken¹,

Franken²

2000

Arq. Bras. Cardiol.

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The patient arrived at the emergency unit with a history of acute myocardial infarction, for which she was treated. Without improvement in the pain, the patient developed heart failure and underwent a hemodynamic study, which showed normal coronary arteries and extensive ventricular impairment. During evolution, the clinical findings improved and herpes zoster appeared on the right shoulder. In a few months the clinical findings subsided, and the findings of the electrocardiogram, chest X-ray, and ventricular function were normal. The patient is currently asymptomatic.Clinical manifestation of myocarditis may vary from an asymptomatic state secondary to focal infection to severe heart failure. In some cases, clinical manifestations may simulate myocardial infarction 1 , as electrocardiographic and laboratory findings do. Approximately 25 viruses may be associated with myocarditis, including the varicella-zoster virus. Myocardial involvement during infection by herpes zoster virus is rare, and when it occurs, it is usually asymptomatic or manifests as heart failure 2 . We report the case of a patient with clinical findings of myocardial infarction and infection by herpes zoster virus. Case ReportThe patient is a white 68-year-old female, who arrived at the emergency unit complaining of precordial pain that irradiated to the left upper limb and was accompanied by sweating and weakness for 3 hours. The patient reported malaise in the previous 2 days, and a continuous discomfort in her right shoulder with no alleviating or worsening factors. The patient was hypertensive and had been using 20mg of enalapril for the last 5 years. She also reported having a family history of longevity.On physical examination the patient was restless, pale, sweating, and dyspneic. Her blood pressure was 134/80m-mHg in both upper limbs, her heart rate was 116bpm, the lungs showed no rales, and the peripheral pulses were palpable.The clinical hypothesis of myocardial infarction led the patient to immediately undergo electrocardiography ( fig. 1), which confirmed the diagnosis. A thrombolytic (streptokinase) was started, and hypotension occurred during infusion; therefore, the dripping was decreased, dopamine was started followed by dobutamine. After infusion, the patient remained restless, more dyspneic, and still complained of pain. On pulmonary auscultation, crepitant rales could be heard in the inferior 2/3 of the lungs. The patient was given sodium nitroprusside and a diuretic. The chest X-ray ( fig. 2) showed the classical pattern of pulmonary edema. As the pain persisted after 4 hours of thrombolytic infusion, the patient underwent coronary angiography, which revealed normal coronary arteries and an increase in left ventricular end-systolic volume due to an extensive anterior and inferior akinetic area, and also apical dyskinesia ( fig. 3). Table I shows the levels of the cardiac enzymes.The echocardiogram of 3/12/96 revealed an ejection fraction of 45%, mild mitral insufficiency, a deficit in left ventricular relaxation, middle api...

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Section: Discussionmentioning

confidence: 92%

Pseudo-myocardial infarction during an episode of herpes zoster

Franken¹,

Franken²

2000

Arq. Bras. Cardiol.

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“…This may manifest either as systolic or diastolic dysfunction. Systolic dysfunction also may be induced by inflammatory cytokines that affect myocardial contractility, [123][124][125][126][127] as well as by increases in both afterload and myocardial-wall stress during rapid changes in cardiac transmural pressure associated with generation of extreme negative intrathoracic pressure during episodes of obstructive apnea. 14,18 Hypertension, together with the trophic effects of substances such as endothelin and catecholamines, may induce structural cardiac changes that may be implicated in diastolic dysfunction.…”

Section: Congestive Heart Failurementioning

confidence: 99%

Obstructive Sleep Apnea

Shamsuzzaman¹,

Gersh²,

Somers³

2003

JAMA

1,015

183

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“… 3 , 4 The pathophysiology of IL-2-induced myocarditis appears to be related to the release of tumor necrosis factor-α and cytokine-mediated myocardial insult, which also contribute to the development of a distributive shock type picture. 2 , 5 , 6 Arrhythmias have been reported with IL-2 use; however, in the case reports most were atrial fibrillation and supraventricular tachycardias and resolved after discontinuation of therapy. 7 , 8 Margolin et al studied 93 patients and showed one incidence of VT out of 20 cases of cardiac arrhythmias.…”

Section: Discussionmentioning

confidence: 87%

A Case of Myocarditis and Near-Lethal Arrhythmia Associated With Interleukin-2 Therapy

Sarcon

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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We present a case of a 48-year-old female who developed myocarditis and near fatal arrhythmias during high dose Il-2 therapy for metastatic renal cancer. On day 5 of therapy, the patient developed sudden onset chest pain, elevated cardiac enzymes and ST segment changes on EKG. Coronary angiogram was normal, however echocardiogram showed reduced ejection fraction and hemodynamic measurements showed elevated bilateral elevated filling pressures. The patient then developed episodes of recurrent ventricular arrhythmia, precipitated by bradycardia and PVC, requiring defibrillation and temporary pacemaker placement. Endomycardial biopsy was nonspecific showing fibrosis with subsequent cardiac MRI showed evidence of myocardial edema, consistent with Il-2 induced myocarditis in the setting of no prior cardiac history. After the discontinuation of Il-2 therapy, the patient displayed clinical improvement as well as improved ejection fraction. This case brings attention to the cardiac toxicities associated with high dose Il-2 therapy including potentially lethal arrhythmias and highlights the importance of careful cardiac screening prior to initiation of treatment.

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Severe Reversible Global and Regional Ventricular Dysfunction Associated with High-Dose Interleukin-2 Immunotherapy

Cited by 20 publications

References 0 publications

Pseudo-myocardial infarction during an episode of herpes zoster

Pseudo-myocardial infarction during an episode of herpes zoster

Obstructive Sleep Apnea

A Case of Myocarditis and Near-Lethal Arrhythmia Associated With Interleukin-2 Therapy

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