Abstract
RATIONALE: Dilated cardiomyopathy (DCM) is a major cause of chronic heart failure, and some patients continue to deteriorate despite guideline-directed medical therapy. Immunoadsorption (IA), which removes pathogenic autoantibodies, has been proposed as a potential adjunctive therapy, but its clinical use remains limited. This case illustrates the potential benefits of IA in advanced, treatment-refractory DCM. PATIENT CONCERNS: A 53-year-old woman with a 9-year history of DCM presented with recurrent chest tightness and dyspnea. Despite long-term guideline-directed medical therapy, her symptoms progressively worsened. DIAGNOSES: The patient had chronic DCM initially diagnosed in the peripartum period, with a left ventricular ejection fraction (LVEF) of 11% at onset. Before IA, echocardiography demonstrated severe systolic dysfunction (LVEF 22%-24%) with significant mitral regurgitation, and laboratory evaluation showed markedly elevated pro-BNP (4454 pg/mL). INTERVENTIONS: The patient underwent two sessions of immunoadsorption in September 2024, followed by high-dose intravenous immunoglobulin (IVIG) as per standard protocols. OUTCOMES: Following treatment, her symptoms improved, pro-BNP decreased to 2109 pg/mL, and repeat echocardiography showed an increase in LVEF to 29.2%. LESSONS: This case suggests that immunoadsorption may offer clinical benefit in patients with advanced, refractory DCM. While promising, IA remains experimental and requires further investigation in larger, controlled studies.