Polymyositis and myocarditis after donor lymphocyte infusion

Area of Science:

• Hematology
• Immunology
• Cardiology

Background:

• Chronic graft-versus-host disease (GVHD) is a significant complication post-hematopoietic stem cell transplantation.
• Polymyositis is an uncommon manifestation of chronic GVHD, particularly after donor lymphocyte infusion (DLI).
• The simultaneous occurrence of polymyositis and myocarditis in this context has not been previously documented.

Purpose of the Study:

• To report a unique case of a patient experiencing both polymyositis and myocarditis after DLI.
• To highlight the diagnostic findings and treatment response in this rare presentation of chronic GVHD.

Main Methods:

• Case presentation of an 18-year-old female post-DLI.
• Clinical evaluation including laboratory tests (muscle enzymes), electromyography, muscle biopsy, ECG, and echocardiography.
• Treatment with high-dose prednisone and tacrolimus.

Main Results:

• The patient presented with symptoms of myositis and ECG/echocardiographic findings indicative of myocarditis.
• Muscle biopsy confirmed CD8+ T cell infiltration.
• Treatment with immunosuppressants resulted in decreased muscle and cardiac enzymes and normalized ECG.
• Follow-up ECG showed complete normalization.

Conclusions:

• Polymyositis and myocarditis can occur concurrently as a rare manifestation of chronic GVHD post-DLI.
• Early diagnosis and aggressive immunosuppressive therapy are crucial for managing this condition.
• This case expands the known spectrum of chronic GVHD complications.