心脏移植术后巨细胞病毒性心肌炎并发排斥反应1例：病例报告及文献复习

Q4 Medicine

Journal of Cardiology Cases Pub Date : 2025-04-01 DOI:10.1016/j.jccase.2024.12.007

Raffaele Abete MD , Attilio Iacovoni MD , Claudia Vittori MD , Roberta Sebastiani MD , Elisabetta Candiago MD , Andrea Gianatti MD , Amedeo Terzi MD , Michele Senni MD

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引用次数: 0

摘要

49岁女性终末期肥厚性心肌病患者行原位心脏移植手术。病人出现早期急性排斥反应。强化治疗导致改善，但巨细胞病毒（CMV）心肌炎出现。积极的治疗，包括大剂量的更昔洛韦和静脉注射免疫球蛋白，导致巨细胞病毒和排斥标志物的阴性。心脏功能恢复，强调挑战和成功的多学科方法在处理复杂的移植后并发症。学习目标诊断和治疗心脏移植并发症，如机会性感染和细胞和/或抗体介导的排斥反应。目的：强调心肌内膜活检在心脏移植监测中的作用。

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A rare case of cytomegalovirus myocarditis complicating rejection after heart transplantation: Case report and review of literature

A 49-year-old female with terminal hypertrophic cardiomyopathy underwent orthotopic heart transplantation. The patient developed early acute rejection. Intensifying therapy led to improvement, but cytomegalovirus (CMV) myocarditis emerged. Aggressive management, including high-dose ganciclovir and intravenous immunoglobulin, resulted in negativization of CMV and rejection markers. Cardiac function recovered, emphasizing the challenges and successful multidisciplinary approach in managing complex post-transplant complications.

Learning objectives

To diagnose and treat complications in heart transplantation, such as opportunistic infections and cellular and/or antibody-mediated rejection. To underline role of endomyocardial biopsy in heart transplant monitoring.

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