Fulminant myocarditis owing to high-dose interleukin-2 therapy for metastatic melanoma

Abstract

ABSTRACT. High-dose interleukin-2 (IL-2) therapy may cause acute myocarditis characterised by diffuse myocardial involvement and occasionally fulminant heart failure. Cardiac MRI (CMRI) provides a comprehensive assessment of myocardial function, inflammation and injury in a single examination and has shown value in the diagnosis of myocarditis. We report a case of a 54-year-old male with metastatic melanoma who developed acute severe myocarditis with fulminant heart failure after high-dose IL-2 therapy. CMRI using a combination of T 2 weighted imaging and T 1 weighted late postgadolinium enhancement techniques played a key role in establishing the diagnosis. To our knowledge we present the first case report of the combined use of T 1 and T 2 weighted CMRI techniques to diagnose IL-2 induced myocarditis.

Transthoracic 3D Echocardiographic Left Heart Chamber Quantification Using an Automated Adaptive Analytics Algorithm

“…Lastly, although these findings were smaller than biases reported in the published data (8)(9)(10), the unadjusted program still underestimated LA and LV volumes compared with CMR. However, this bias was significantly reduced with the use of contour adjustment.…”

Drugs That May Cause or Exacerbate Heart Failure

“…175 Similarly, high-dose interleukin-2 has been associated with fulminant myocarditis, which is poorly understood but may be related to the capillary leak syndrome and cytotoxic damage from migration of lymphocytes and inflammatory cells to the interstitum. 176 High-dose interferon inhibits cell growth and upregulates immunological cancer defenses. Studies in animal models suggest a dose-dependent negative inotropic effect of interferon-α that may be mediated in part by nitric oxide.…”

When Lightning Strikes

“…2 The cause of fulminant myocarditis historically was often an enteroviral (eg, Coxsackie virus) infection. As enterovirus prevalence has waned, new causes of fulminant myocarditis, including H1N1 influenza, 3 and drug-related eosinophilic myocarditis 4,5 have emerged.…”