Bartz-Overman Colin, Li Sarah, Puligandla Balaram, Colaco Nalini, Steiner Johannes, Masha Luke
Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, OR, USA.
Eur Heart J Case Rep. 2024 Mar 14;8(4):ytae128. doi: 10.1093/ehjcr/ytae128. eCollection 2024 Apr.
Giant cell myocarditis (GCM) is an inflammatory form of acute heart failure with high rates of cardiac transplantation or death. Standard acute treatment includes multi-drug immunosuppressive regimens. There is a small but growing number of case reports utilizing rabbit anti-thymocyte globulin in severe cases.
Two cases are presented with similar presentations and clinical courses. Both are middle-aged patients with no significant past medical history, who presented with new acute decompensated heart failure that quickly progressed to cardiogenic shock requiring inotropic and mechanical circulatory support. Both underwent endomyocardial biopsies that diagnosed GCM. Both were treated with a multi-agent immunosuppressive regimen, notably including rabbit anti-thymocyte globulin, with subsequent resolution of shock and recovery of left ventricular ejection fraction. Both remain transplant-free and without ventricular arrhythmias at 7 months and 26 months, respectively.
In aggregate, these cases are typical of GCM. They add to growing observational data that upfront rabbit anti-thymocyte globulin may reduce morbidity and mortality in GCM, including potentially preventing the need for complex interventions like orthotopic heart transplantation.
巨细胞性心肌炎（GCM）是急性心力衰竭的一种炎症形式，心脏移植率或死亡率很高。标准的急性治疗包括多药免疫抑制方案。有少量但数量在增加的病例报告显示，在严重病例中使用兔抗胸腺细胞球蛋白。
介绍了两例表现和临床病程相似的病例。两例均为中年患者，既往无重大病史，均因新发急性失代偿性心力衰竭就诊，很快进展为心源性休克，需要使用正性肌力药物和机械循环支持。两人均接受了心内膜心肌活检，诊断为GCM。两人均接受了多药免疫抑制方案治疗，特别是包括兔抗胸腺细胞球蛋白，随后休克得到缓解，左心室射血分数恢复。两人分别在7个月和26个月时仍未进行心脏移植，且无室性心律失常。
总体而言，这些病例是GCM的典型病例。它们增加了越来越多的观察数据，即早期使用兔抗胸腺细胞球蛋白可能降低GCM的发病率和死亡率，包括可能避免进行原位心脏移植等复杂干预措施的必要性。
