Steroid-induced hypertrophic cardiomyopathy following stem cell transplantation in a neonate: a case report

Abstract

Summary:We report a case of severe left ventricular outflow tract obstruction complicating steroid therapy in an infant undergoing allogeneic transplant in the first few weeks of life for treatment of Krabbe's disease. While this complication is well known to those treating premature infants, it has not been reported in the stem cell transplant setting. For young infants undergoing allogeneic transplant who require steroid therapy, cardiac monitoring after 2-3 weeks of therapy is recommended. Bone Marrow Transplantation (2001) 27, 1105-1108.

Hypertrophic Obstructive Cardiomyopathy in An Infant With Hemophagocytic Lymphohistiocytosis; Answer to a Riddle

“…11,12 It tends to resolve within 1 to 2 weeks after cessation of the steroid therapy, whereas it might remain longer in older infants and adolescents. [11][12][13] Furthermore, steroid-induced fluid and electrolyte retention is usually augmented by the existing increased capillary permeability secondary to the cytokine storm of HLH. 5 The resultant severe myocardial interstitial edema presents with a picture of pseudo LVH.…”

Success for pig-to-baboon heart transplants

“…Third, they modified the standard hormonetreatment regimen. The steroid cortisone is typically given to transplant recipients to aid immunosuppression, but can cause heart overgrowth in newborn babies that receive stemcell transplants 9 . The authors therefore tapered cortisone treatment much more quickly than they had for their first group of baboons, minimizing levels of the drug by three weeks after surgery.…”

Molecular characterisation of neonatal cardiac hypertrophy and its regression

“…4,10 Recently, a similar phenotype including natural regression has been reported in newborns who have been exposed to corticosteroids. 2,3,5,11 Antenatal corticosteroids are commonly used for preventing mortality and morbidity from respiratory distress and intraventricular haemorrhage of premature birth, 5 while postnatal corticosteroids are used for the treatment of brochopulmonary dysplasia, especially in preterm infants. 2,3 Neonatal cardiac hypertrophy has also been encountered postnatally in recipients of allogeneic transplants treated with corticosteroids.…”

“…2,3 Neonatal cardiac hypertrophy has also been encountered postnatally in recipients of allogeneic transplants treated with corticosteroids. 11 To understand cardiac hypertrophy in newborns, rat models have been established related both to diabetic pregnancies and induction with corticosteroids.Abstract Neonatal cardiac hypertrophy associated with diabetic pregnancy is transient and regresses naturally, but is associated with increased morbidity and mortality.This study was undertaken to analyse the changes in expression of 5 cardiac genes, including atrial natriuretic peptide, ␣-and ␤-myosin heavy chain, and cardiac and skeletal ␣-actin genes, using a rat neonatal model, in which cardiac hypertrophy was induced via maternal diabetes.In the hypertrophied left ventricle of neonates from diabetic mothers, the levels of mRNA from all the above genes except skeletal ␣-actin were increased by between 1.8-and 12-fold compared with the controls at birth (p Ͻ 0.05). In the first 28 days, the level of mRNA for ␣-myosin heavy chain increased slightly, while that for atrial natriuretic peptide and ␤-myosin heavy chain decreased continuously similar to the controls, but at a significantly faster rate.…”

“…2,3 Neonatal cardiac hypertrophy has also been encountered postnatally in recipients of allogeneic transplants treated with corticosteroids. 11 To understand cardiac hypertrophy in newborns, rat models have been established related both to diabetic pregnancies and induction with corticosteroids. [12][13][14] These models mimic the human neonatal phenotype.…”