Giant cell myocarditis: first report of disease recurrence in the transplanted heart.

A 51-year-old female underwent heart transplantation for endomyocardial biopsy-proved giant cell myocarditis complicated by rapidly progressive congestive heart failure unresponsive to immunosuppression. Preoperatively there was no evidence of an associated extracardiac granulomatous disease. Twenty-one months after heart transplantation, giant cell myocarditis recurred in the allograft associated with sustained ventricular arrhythmias. There remained an absence of concomitant extracardiac granulomatous diseases and infections. Increased corticosteroid therapy cleared myocardial inflammation but did not abolish ventricular arrhythmias, which required pharmacologic intervention and the insertion of an Intertach II antitachycardia pacemaker. Compared with a value of 0.56 obtained 1 year after heart transplantation, left ventricular ejection fraction decreased to 0.29 at the time of diagnosis of giant cell myocarditis and remained subnormal 6 months later. Because giant cell myocarditis can recur in the allograft, the candidacy of patients with this disease for heart transplantation must be carefully assessed.