Background

Acute fulminant myocarditis in children is associated with elevated mortality and morbidity with few advances in its medical management. Here we report a preliminary experience of children treated with IL-1 receptor antagonist associated with rapid myocardial function recovery.

Methods

A retrospective case series of children admitted in the Pediatric Intensive Care Unit of the Bicêtre Hospital (AP–HP Paris Saclay University) between April 2020 and January 2022 with acute myocarditis. Children were treated with subcutaneous anakinra (an IL-1 receptor antagonist). Patients characteristics, and outcome are reported.

Results

Of 10 children admitted with acute fulminant myocarditis, eight were treated with sub-cutaneous anakinra. Seven children had SARS-CoV-2 post-infective myocarditis associated with multisystem inflammatory syndrome in children (MIS-C) and one child Parvovirus B19 myocarditis. In all patients a rapid (< 24 h) improvement in myocardial function was observed with concomitant decrease in myocardial enzymes. All patients survived with full myocardial recovery.

Conclusions

In this pilot study, use of IL-1 receptor antagonist in the initial treatment of acute fulminant myocarditis in children seems to be associated with rapid stabilization and recovery.

中文翻译：

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小儿急性暴发性心肌炎中的阿那白滞素

背景

儿童急性暴发性心肌炎与死亡率和发病率升高有关，但其医疗管理进展甚微。在这里，我们报告了用 IL-1 受体拮抗剂治疗与快速心肌功能恢复相关的儿童的初步经验。

方法

2020 年 4 月至 2022 年 1 月期间在 Bicêtre 医院（AP-HP 巴黎萨克雷大学）儿科重症监护室收治的儿童急性心肌炎的回顾性病例系列。儿童接受皮下阿那白滞素（一种 IL-1 受体拮抗剂）治疗。报告患者特征和结果。

结果

在 10 名因急性暴发性心肌炎入院的儿童中，8 名接受了皮下阿那白滞素治疗。7 名儿童患有与儿童多系统炎症综合征 (MIS-C) 相关的 SARS-CoV-2 感染后心肌炎和 1 名儿童细小病毒 B19 心肌炎。在所有患者中，观察到心肌功能快速（< 24 小时）改善，同时心肌酶降低。所有患者均存活，心肌完全恢复。

结论

在这项初步研究中，在儿童急性暴发性心肌炎的初始治疗中使用 IL-1 受体拮抗剂似乎与快速稳定和恢复有关。