A case of chronic myocarditis remitted by immunosuppressive and central extracorporeal membrane oxygenation therapy

Abstract

The concept and therapeutic strategy for chronic lymphocytic myocarditis remain unestablished. We had a 57-year-old man with advanced biventricular (predominantly right ventricular) failure due to chronic lymphocytic myocarditis. He received central extracorporeal membrane oxygenation therapy that was explanted on day 129 following the aggressive steroid pulse and plasma exchange therapy. Infiltration of inflammatory cells persisted even after the device removal, which required long-term oral steroid administration after the index discharge on day 200. High-sensitivity cardiac troponin T level was normalized and inflammatory cell infiltration was remitted following post-discharge 4-month 10 mg/day prednisolone therapy. Aggressive immunosuppressive therapy under mechanical circulatory support might be a promising strategy for those with chronic lymphocytic myocarditis. <Learning objective: "Chronic myocarditis" does not exist as a formal classification of myocarditis worldwide and therapeutic strategy remains controversial. Aggressive immunosuppressive therapy under mechanical circulatory support might be a promising strategy for chronic lymphocytic myocarditis.>.

Keywords: Corticosteroids; Mechanical circulatory support; Unloading.