Temporary left ventricular assist device for complete recovery from reversible acute heart failure due to tumor necrosis factor-α inhibitor

We present the case of a 38-year-old woman with symptoms of acute heart failure (HF). In the previous months, she received tumor necrosis factor (TNF)-α inhibitors for the treatment of arthritis secondary to Crohn’s disease. She initially received etanercept (Enbrel) for nearly 1 year and subsequently received infliximab (Remicade) for 6 months. Echocardiograms following the etanercept therapy were normal. Since her disease did not respond well to etanercept, she received 16 treatments of infliximab, at the end of which HF symptoms developed, with rapid clinical deterioration. Her echocardiogram demonstrated dilated cardiomyopathy with severe biventricular dysfunction and left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) <20% with severe functional mitral and tricuspid regurgitation. Her extensive diagnostic work-up, including pathological examination of endomyocardial biopsy, was normal. Despite optimal treatment of HF, her status did not improve, and a left ventricular assist device (LVAD, HeartMate II) was implanted. The evolution was unremarkable, and she rapidly recovered in the following months, with LVEF reaching ≥45%. Based on the patient’s clinical improvement and LVEF recuperation, LVAD was removed. Her functional status and LVEF remained stable after LVAD explantation. Therefore, the very probable etiology of the precipitated HF was infliximab toxicity