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.
Keywords: Antibody-mediated rejection; Cellular rejection; Cytomegalovirus myocarditis; Heart transplant; Intravenous immunoglobulins.
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