Giant cell myocarditis treated with long-term multi-modal care with multiple mechanical circulatory support: case report

Figures

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  Figure 1. (A): The voltage of the electrocardiograms decreased with worsening giant cell myocarditis but was finally improved by multidisciplinary treatment. (B): In chest radiography, the pulmonary edema was getting worse and the clinical course of myocarditis markings were observed. Finally, the findings were improved with multidisciplinary treatment. (C): After the administration of mycophenolate mofetil, the serum troponin T levels gradually decreased along with a gradual improvement in the left ventricular ejection fraction. CMV; cytomegalovirus, CRBSI; catheter-related blood stream infections, CRRT; continuous renal replacement therapy, ECMO; extracorporeal membrane oxygenation, IRRT; intermittent renal replacement therapy, MMF; mycophenolate mofetil, mPSL; methylprednisolone, PSL; prednisolone, SvO2: Mixed venous oxygen saturation.

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  Figure 2. On admission (A: End-systolic, B: End-diastolic) shows severely depressed left ventricular (LV) systolic dysfunction with an LV ejection fraction (LVEF) as low as 38% in transthoracic echocardiography. Finally, LVEF recovered to 54% (C: End-systole, D: End-diastole).

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  Figure 3. Histological findings of Hematoxylin and eosin staining obtained from the right ventricular septal (A: ×40, B: ×100). Figure 3-A shows severe myocardial contusion (arrow). Figure 3-B shows the infiltration of lymphocytes, eosinophils and giant cells (arrow). The invasion of CD3 positive T cells (C: ×40) and CD68 positive macrophage (D: ×40) was consistent with the infiltration of giant cells.