High dose immune globulin therapy ameliorates peripartum cardiomyopathy with elevated serum antibody titer to influenza virus: case report of two patients.

BACKGROUND: Peripartum cardiomyopathy (PPCM) is a rare complication characterized by heart failure that arises between the last month of pregnancy and the first 5 months after delivery. The etiology of this disorder has not been clarified due to its low incidence. We describe two patients with PPCM and elevated antibody titers to influenza virus in paired sera that were recovered by high doses of intravenous immune globulin. CASE REPORT: Case 1. One day before delivery by cesarean section, a 32-year-old woman developed PPCM that was immediately improved after the administration of a total cumulative dose of 1.7 g/kg immunoglobulin together with intra-aortic balloon pumping and percutaneous cardiopulmonary support. Antibody titers to influenza virus subtypes A and B were elevated in paired sera from this patient. Case 2. Four days postpartum, a 29-year-old woman developed PPCM and a total of 2.0 g/kg immunoglobulin recovered her cardiac function. The antibody titer to influenza virus subtype B was elevated in paired sera from this patient. Evidence of myocarditis was absent in endomyocardial specimens from both patients. CONCLUSIONS: These cases suggest that viral infection including influenza contributes to PPCM and that high doses of immunoglobulin constitute an effective treatment for this disorder.