Tompkins Rose, Cole William J, Rosenzweig Barry P, Axel Leon, Bangalore Sripal, Lala Anuradha
Department of Cardiology, New York University Langone Medical Center, New York, NY 10016, USA.
Department of Radiology, New York University School of Medicine, New York, NY 10016, USA.
Case Rep Cardiol. 2015;2015:173826. doi: 10.1155/2015/173826. Epub 2015 Jul 16.
Giant cell myocarditis is a rare and often fatal disease. The most obvious presentation often described in the literature is one of rapid hemodynamic deterioration due to cardiogenic shock necessitating urgent consideration of mechanical circulatory support and heart transplantation. We present the case of a 60-year-old man whose initial presentation was consistent with myopericarditis but who went on to develop a rapid decline in left ventricular systolic function without overt hemodynamic compromise or dramatic symptomatology. Giant cell myocarditis was confirmed via endomyocardial biopsy. Combined immunosuppression with corticosteroids and calcineurin inhibitor resulted in resolution of symptoms and sustained recovery of left ventricular function one year later. Our case highlights that giant cell myocarditis does not always present with cardiogenic shock and should be considered in the evaluation of new onset cardiomyopathy of uncertain etiology as a timely diagnosis has distinct clinical implications on management and prognosis.
巨细胞性心肌炎是一种罕见且常致命的疾病。文献中常描述的最明显表现是由于心源性休克导致的快速血流动力学恶化，需要紧急考虑机械循环支持和心脏移植。我们报告一例60岁男性病例，其最初表现与心肌心包炎一致，但随后左心室收缩功能迅速下降，而无明显血流动力学损害或显著症状。通过心内膜心肌活检确诊为巨细胞性心肌炎。联合使用皮质类固醇和钙调神经磷酸酶抑制剂进行免疫抑制治疗，一年后症状缓解，左心室功能持续恢复。我们的病例强调，巨细胞性心肌炎并不总是表现为心源性休克，在评估病因不明的新发心肌病时应考虑到该病，因为及时诊断对治疗和预后具有明显的临床意义。
