Sirolimus for Recurrent Giant Cell Myocarditis After Heart Transplantation: A Unique Therapeutic Strategy

Apurva D. Patel, Brian Lowes, Mohammed A. Chamsi-Pasha, Stanley J. Radio, Marshall Hyden, Ronald Zolty

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)600-603
Number of pages4
JournalAmerican journal of therapeutics
Volume26
Issue number5
DOIs
StatePublished - Sep 1 2019

Fingerprint

Myocarditis
Giant Cells
Sirolimus
Heart Transplantation
Immunosuppressive Agents
Adrenal Cortex Hormones
Mycophenolic Acid
Antilymphocyte Serum
Fatal Outcome
Macrolides
Azathioprine
Tacrolimus
Therapeutics
Methotrexate
Crohn Disease
Immunosuppression
Cyclosporine
Disease-Free Survival
B-Lymphocytes
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Sirolimus for Recurrent Giant Cell Myocarditis After Heart Transplantation : A Unique Therapeutic Strategy. / Patel, Apurva D.; Lowes, Brian; Chamsi-Pasha, Mohammed A.; Radio, Stanley J.; Hyden, Marshall; Zolty, Ronald.

In: American journal of therapeutics, Vol. 26, No. 5, 01.09.2019, p. 600-603.

Research output: Contribution to journalArticle

Patel, Apurva D. ; Lowes, Brian ; Chamsi-Pasha, Mohammed A. ; Radio, Stanley J. ; Hyden, Marshall ; Zolty, Ronald. / Sirolimus for Recurrent Giant Cell Myocarditis After Heart Transplantation : A Unique Therapeutic Strategy. In: American journal of therapeutics. 2019 ; Vol. 26, No. 5. pp. 600-603.
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