Influenza Myocarditis Treated With Antithymocyte Globulin

Pediatrics. 2018 Nov;142(5):e20180884. doi: 10.1542/peds.2018-0884. Epub 2018 Oct 23.

Abstract

Influenza is a cause of significant morbidity and mortality worldwide. Myocarditis is a rare complication of the virus and can vary widely in severity. The published cases of influenza B myocarditis in children tend to be severe with a high mortality rate. Current standard treatment of viral myocarditis is supportive care, although immunomodulatory therapies, such as steroids and intravenous immunoglobulin, are often used. T cells have been implicated in causing significant myocyte damage in myocarditis by leading to the downstream production of antibodies against viral and myocyte antigens; this has created a theoretical basis for the use of antithymocyte globulin to target T cells in these patients. We present a case of acute fulminant influenza B myocarditis in a pediatric patient that required mechanical circulatory support and improved only after treatment with antithymocyte globulin.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Antilymphocyte Serum / therapeutic use*
  • Echocardiography
  • Electrocardiography
  • Extracorporeal Membrane Oxygenation / methods
  • Female
  • Humans
  • Influenza B virus / immunology
  • Influenza, Human / complications*
  • Influenza, Human / therapy
  • Myocarditis / therapy*
  • Myocarditis / virology

Substances

  • Antilymphocyte Serum