Murphy Joseph G, Wright R Scott, Bruce G Keith, Baddour Larry M, Farrell Michael A, Edwards William D, Kita Hirohito, Cooper Leslie T
Division of Cardiovascular Diseases, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
Lancet. 2003 Oct 25;362(9393):1378-80. doi: 10.1016/S0140-6736(03)14635-1.
Smallpox is an eradicated viral disease that has re-emerged as a potential bioterrorism threat. Smallpox vaccination was historically the most effective defence measure against wild smallpox virus. The risk of myopericarditis after vaccination might limit this option. We report a case of biopsy-proven eosinophilic-lymphocytic myocarditis diagnosed in vivo with histological evidence for eosinophil-mediated cardiac myocyte necrosis shortly after smallpox vaccination. Furthermore, we report a beneficial haemodynamic response to high-dose corticosteroids. A better understanding of the aberrant immune mechanism of myocyte injury after smallpox vaccination might improve the risk/benefit assessment for people considering smallpox vaccination and better smallpox vaccines in the future.
天花是一种已被根除的病毒性疾病，但又重新成为一种潜在的生物恐怖主义威胁。历史上，天花疫苗接种是预防野生天花病毒最有效的防御措施。接种疫苗后发生心肌炎的风险可能会限制这一选择。我们报告了一例经活检证实的嗜酸性粒细胞-淋巴细胞性心肌炎病例，该病例在接种天花疫苗后不久通过体内诊断发现有嗜酸性粒细胞介导的心肌细胞坏死的组织学证据。此外，我们报告了高剂量皮质类固醇治疗产生了有益的血流动力学反应。更好地了解天花疫苗接种后心肌细胞损伤的异常免疫机制，可能会改善考虑接种天花疫苗人群的风险/收益评估，并在未来研发出更好的天花疫苗。
