Hypersensitivity myocarditis

Hypersensitivity myocarditis - Hypersensitivity myocarditis is not dose-dependent and may occur at any time during treatment. 

Tricyclic antidepressants rarely cause cholestatic jaundice and agranulocytosis due to hypersensitivity reactions. The rare liver necrosis may reflect severe hypersensitivity. Two fatal cases of hypersensitivity myocarditis and hepatitis have been described (1). A variety of dermatological manifestations have been reported (rash, urticaria, vasculitis), but their relation to drug ingestion is often uncertain. A single case of pulmonary hypersensitivity with... 

Morrow PL, Hardin NJ, Bonadies J. Hypersensitivity myocarditis and hepatitis associated with imipramine and its metabohte, desipramine. J Forensic Sci 1989 34(4) 1016-20. 

In isolated cases, cefalotin (3) and cefaclor (4) have been suspected to cause hypersensitivity myocarditis. 

Burke AP, Saenger J, Mullick F, Virmani R. Hypersensitivity myocarditis. Arch Pathol Lab Med 1991 115(8) 764-9. 

Beghetti M, Wilson GJ, Bohn D, Benson L. Hypersensitivity myocarditis caused by an allergic reaction to cefaclor. J Pediatr 1998 132(l) 172-3. 

Intravenous phenytoin can cause cardiac dysrhythmias, hypotension, and potentially fatal cardiovascular collapse, especially if the highest recommended infusion rate (50 mg/minute or 1 mg/kg/minute in children) is exceeded. One case of hypersensitivity myocarditis was probably initiated by phenytoin, although carbamazepine may have contributed (SED-13,142) (3). 

Allergic reactions to tetracyclines are less than half as common as allergic reactions to penicillin. For this reason, tetracyclines are alternatives in patients with allergic reactions to other antibiotics. Exceptional observations of anaphylactic shock have been reported (37,38). In a few cases tetracychnes were assumed to be the cause of hypersensitivity myocarditis (39). Pneumonitis with eosinophiha has been described in association with tetracychnes (40). A serum sickness-hke syndrome was probably associated with minocycline in a 19-year-old man treated for acne (41). Allergic and toxic reactions may in some cases have been caused by degraded formulations or additives (42). Tumor-inducing effects have not been reported. 

Fenoglio JJ Jr., McAUister HA Jr., MuUick FG. Drug related myocarditis. I. Hypersensitivity myocarditis. Hum Pathol 1981 12(10) 900-7. 

Another type of gross morphologic lesion in the heart muscle is hypersensitivity myocarditis. This is an inflammatory response that is the most common type of heart disease associated with drug use. There are five primary clinical criteria for diagnosis of this... 

Zaacks SM, Klein L, Tan CD, Rodriguez ER, Leikin JB. Hypersensitivity myocarditis associated with ephedra use. J Toxicol Clin Toxicol 1999 37(4) 485 189. 

An isolated report describes an epileptic patient taking phenytoin who died, probably from hypersensitivity myocarditis, two days after receiving immunoglobulins for Guillain-Barre syndrome. 

Koehler PJ, Koudstaal J, Lethal hypersensitivity myocarditis associated with the use of intravenous gammaglobulin for Guillain-Barrd syndrome, in combinaticm with f enytoin. J Neurol... 

Fenoglio JJ, McAllister HA, Mullick FG. Drug related myocarditis.I. Hypersensitivity myocarditis. HumPa tol( 9Sl) 12,900-7. 

Conston AS (1974) Hypersensitivity myocarditis a fatal reaction. J Med Soc NJ 71 61 Coombs RRA, Gell GPH (1953) Classification of allergic reactions responsible for clinical hypersensitivity and disease. In Gell PG, Coombs RRA (eds) Clinical aspects of immunology. Blackwell Scientific, Oxford, pp 575-596... 

In a case of acute hypersensitivity myocarditis secondary to carbamazepine, diagnosed post-mortem, there was diffuse infiltration of the myocardium by eosinophils and ljmiphocj4 es, with myocyte damage death was due to cardiogenic shock [110 ]. 

Pursnani A, Yee H, Slater W, Sarswat N. Hypersensitivity myocarditis associated with azithromycin exposure. Aim Intern Med 2009 150(3) 225-6. 

Hypersensitivity Anaphylactoid purpura, anaphylaxis, angioneurotic edema, myocarditis, pericarditis, polyarthralgia, pulmonary infiltrates with eosinophilia, systemic lupus erythematous exacerbation, urticaria hypersensitivity syndrome (cutaneous reaction, eosinophilia, and one or more of the following Hepatitis, pneumonitis, nephritis, myocarditis, pericarditis, fever, lymphadenopathy). Muscuioskeietai - ArVr ra g a, arthritis, bone discoloration, joint stiffness and swelling, myalgia, polyarthralgia. 

Cardiovascular effects. Hypotension and tachycardia occur in most patients taking clozapine. Cases of potentially fatal myocarditis and dilated cardiomyopathy have been reported in association with clozapine (Kilian et al. 1999). Myocarditis typically occurred within 3 weeks of starting clozapine, but cardiomyopathy may not be apparent for several years. Although rare, treatment-emergent myocarditis and cardiomyopathy occur at a reportedly higher incidence with clozapine than with other antipsychotics (Coulter et al. 2001). The mechanism by which clozapine may cause myocarditis has not been established, but some authors have speculated that clozapine may cause an immunoglobuhn E (IgE)-mediated type 1 hypersensitivity reaction (Kihan et al. 1999) or a hypereosinophilic syndrome (Hagg et al. 2001). 

Immune vasculitis can also be induced by drugs. The sulfonamides, penicillin, thiouracil, anticonvulsants, and iodides have all been implicated in the initiation of hypersensitivity angiitis. Erythema multiforme is a relatively mild vasculitic skin disorder that may be secondary to drug hypersensitivity. Stevens-Johnson syndrome is probably a more severe form of this hypersensitivity reaction and consists of erythema multiforme, arthritis, nephritis, central nervous system abnormalities, and myocarditis. It has frequently been associated with sulfonamide therapy. Administration of nonhuman monoclonal or polyclonal antibodies such as rattlesnake antivenin may cause serum sickness. 

Potentially fatal eosinophilic myocarditis may be a manifestation of carbamazepine hypersensitivity (SEDA-22, 86). 

The administration of equine or other immunoglobulins is associated with a considerable risk of adverse effects and can produce virtually any type of early or late hypersensitivity reaction, ranging from asthma and urticaria to serum sickness and fatal anaphylaxis (103-106). Encephalitis (107), myocarditis (108), nephritis (109), and uveitis (110) can all be manifestations of such reactions. In one case, leukocytoclastic vasculitis was attributed to human immunoglobulin (96). 

Daniels PR, Berry GJ, Tazelaar HD, Cooper LT. Giant cell myocarditis as a manifestation of drug hypersensitivity. Cardiovasc Pathol 2000 9(5) 287-91. 

Tahercio CP, Olney BA, Lie JT. Myocarditis related to drug hypersensitivity. Mayo Chn Proc 1985 60(7) 463-8. 

Cardiovascular reactions can be due to sulfonamide myocarditis or systemic vascular collapse, owing to severe adverse events such as widespread skin disease. Sulfonamide myocarditis has been described in relation to earlier sulfonamides and occurs in combination with other hypersensitivity reactions (13). 

Adverse reactions to penicillins are rare diarrhoea can occur due to alteration in normal gastrointestinal bacteria. In fact, penicillins are probably the least toxic drugs known. Hypersensitivity reactions to penicillins occur in up to 10% of patients and vary from mild skin rashes to exfoliative dermatitis and Stevens-Johnson syndrome (immune vasculitis with arthritis, nephritis, central nervous system abnormalities and myocarditis) and from bronchoconstriction to life-threatening anaphylactic shock. 

The second adverse effect is not so firmly established as hepatotoxicity. Con-STON (1974) reported a fatal case of myocarditis which he claimed was caused by a hypersensitivity reaction to methyldopa five more fatal cases were reported by Mullick and McAllister (1977). The latter five patients all had associated hepatic lesion. The main piece of evidence cited which the authors claim suggested an immunological mechanism was that histology of the lesions showed a lymphocyte infiltration with a large number of eosinophils. 

Similar histological changes were seen in the cases reported by Mullick and McAllister (1977). Since the development of myocarditis was totally unexpected in these patients and the diagnosis made only at autopsy, there were no investigations carried out to determine the etiology. Thus, a hypersensitivity reaction, al-... 

Cardiovascular Fulminant myocarditis can rarely result from a hypersensitivity reaction to azithromycin, as in the case of a 48-year-old man [113 ]. 

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