A Rare Case of Giant Cell Myocarditis.
There were no underlying skull fractures. There was no evidence of meningeal or intraparenchymal cerebral haemorrhage. He had an enlarged heart that was dilated, and weighed 500 g, with left ventricular wall thickness of 1 cm. The cut-surface of the left ventricle was somewhat salmon pink and firm (Figure 1). The heart had the usual anatomic arrangement of chambers and great vessels and the coronary arteries were patent. He had bilateral pleural effusions and multiorgan
congestion, consistent with heart failure.
These false negative findings may be due to the patchy nature of the inflammatory disease, previous treatment of other entities, thereby masking the findings of GCM, or inadequate sampling. Also, sampling may not reveal the multinucleated giant cells, and a misdiagnosis of lymphocytic myocarditis might be made instead. Most patients with GCM (≥75%) present with rapidonset congestive heart failure, but other presenting symptoms and signs include refractory ventricular tachycardia, complete heart block and acute myocardial infarction.2,3,8,9,11,12 Sudden death is a
less common presentation.
Instead, individuals with GCM may present clinically with an atrial variant and this atrial form has a less fulminant course. Also, individuals with GCM maybe disguised/ misdiagnosed for years as having a monosymptomatic heart block or dilated cardiomyopathy. Ekström et al showed that there were stand-alone factors that could determine persons survivability, even without immunosuppressive therapy. They showed that the severity of myocardial injury, and to a lesser
degree, cardiac dysfunction at presentation, constituted the key predictors of transplant-free cardiac survival in GCM.
Heart Res Open J. 2020; 7(1): 7-10. doi: 10.17140/HROJ-7-154
