Idiopathic giant cell myocarditis: a case report

Giant cell myocarditis causing sudden death in a patient with sarcoidosis

Giant cell myocarditis (GCM) is a rare and rapidly fatal cardiovascular condition most often seen in young adults. It is characterized microscopically by myocardial necrosis with multinucleated giant cells in the absence of well-defined granulomas. This disorder has typically been attributed to manifest as heart failure, but in some individuals, GCM may present as sudden cardiac death. Herein, we present a fatal case of GCM in a 36-year-old male with a history of autoimmune disorders. The decedent presented to the emergency room due to vomiting and was treated for nausea due to suspected dehydration. He was discharged that night and found dead on his bathroom floor the following day. Postmortem examination revealed psoriasis and granulomatous lesions in the lungs consistent with sarcoidosis, further supporting circumstantial evidence existing between GCM and autoimmune disorders. Additionally, this case provides an opportunity to distinguish GCM from the distinct clinical entity of cardiac sarcoidosis (CS), especially in the setting of systemic sarcoidosis. We hope to raise awareness of this rare disease process and its potential to cause sudden cardiac death so that it may be considered in a differential diagnosis as immunosuppression and early cardiac transplantation largely determine the prognosis.

Sudden cardiac death due to ventricular fibrillation in a case of giant cell myocarditis

A 70-year-old woman was admitted to our hospital complaining of shortness of breath. She was diagnosed with acute decompensated heart failure due to left ventricular dysfunction. Her symptoms began to improve with standard therapy for heart failure with diuretics, noninvasive pressure ventilation, and inotropes, but paroxysmal atrial fibrillation and premature ventricular contractions (PVCs) occurred. After treatment with amiodarone, the number of PVCs decreased, and the left ventricular wall motion gradually improved. However, on day 28, ventricular fibrillation and cardiopulmonary arrest occurred suddenly, and she could not be resuscitated. She was diagnosed with giant cell myocarditis via an autopsy. The autopsy revealed diffuse inflammatory cells that comprised giant cells and eosinophils as well as cellular degeneration and necrosis. <Learning objective: We herein report a case of sudden cardiac death due to giant cell myocarditis diagnosed at an autopsy.>.

Giant cell myocarditis presenting with acute heart failure

Idiopathic giant cell myocarditis (GCM) is a rare and rapidly progressing form of myocarditis predominantly affecting younger people. We report a case of a 23-year-old athletic patient who presented with features of acute heart failure due to GCM and discuss his management that included a left ventricular assist device as a bridge to transplant. He died immediately following the transplant.We also review the literature on this rare disease, highlighting the advances in the management of the disease including immunosuppressive therapy, ventricular assist devices and heart transplantation.

Sudden Death Due to Giant Cell Myocarditis: A Case Report

The definition of sudden death is variable and there has been no single all-purpose definition. Sudden death can be defined as sudden or unexpected death in an otherwise healthy individual who is not known to have been suffering from any dangerous disease, injury or poisoning and is found dead or dies within 24 hours after the onset of terminal illness. Some authorities limit the duration to 1 hour. Because of the sudden and unexpected nature of death, inquest is conducted in such cases to rule out foul play and ascertain the cause of death. A vast majority of cases are due to cardiac origin followed by respiratory, neurological, gastrointestinal and genitourinary causes. The most common cardiac disease to cause sudden death is ischemic heart disease as a result of coronary atherosclerosis. Coronary artery disease, cardiomyopathies and electrophysiologic abnormalities are the common causes of sudden cardiac deaths. We present a rare case of sudden death in a healthy adult male due to giant cell myocarditis.