Kong G, Madden B, Spyrou N, Pomerance A, Mitchell A, Yacoub M
Harefield Hospital, Middlesex, U.K.
Eur Heart J. 1991 Apr;12(4):554-7. doi: 10.1093/oxfordjournals.eurheartj.a059938.
A 35-year-old man developed giant cell myocarditis resulting in severe congestive cardiac failure. He needed urgent orthotopic cardiac transplantation despite maximal doses of inotropes and augmentation with an intra-aortic balloon pump. The patient presented with rhythm disturbances and echocardiographically diminished ventricular function at subsequent follow-up. Biopsies then taken revealed recurrence of myocarditis in the transplanted heart. Investigations revealed no obvious cause for the myocardial granulomas nor any evidence of systemic granulomatous disease. The patient received, in addition to maintenance cyclosporin A and azathioprine, high doses of corticosteroids which resulted in complete resolution of the inflammatory process and no recurrence has been detected to date. This case shows that giant cell myocarditis can recur in the transplanted heart despite routine immunosuppression with azathioprine and cyclosporin A and that additional treatment with high dose corticosteroids is effective in causing regression of the inflammatory process.
一名35岁男性患上巨细胞性心肌炎，导致严重的充血性心力衰竭。尽管使用了最大剂量的强心剂并通过主动脉内球囊泵进行辅助，但他仍需要紧急进行原位心脏移植。在随后的随访中，患者出现了心律失常，超声心动图显示心室功能减弱。当时所取的活检显示移植心脏中存在心肌炎复发。检查未发现心肌肉芽肿的明显病因，也没有任何系统性肉芽肿病的证据。除了维持使用环孢素A和硫唑嘌呤外，患者还接受了大剂量的皮质类固醇治疗，这使得炎症过程完全消退，迄今为止未检测到复发。该病例表明，尽管常规使用硫唑嘌呤和环孢素A进行免疫抑制，但巨细胞性心肌炎仍可在移植心脏中复发，而大剂量皮质类固醇的额外治疗可有效促使炎症过程消退。
