Immunosuppressive Treatment in Fulminant Myocarditis and Gene Expression Pattern Associated with, But no Histological Confirmation of Giant Cell Myocarditis

Figures

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  Figure 1. (A) Histology with atrophic myocytes (mean diameter: 14 μm) in regular arrangement. Blood vessels displaying thickened walls and normal endothelia. In the surrounding of vessels slight fibrosis, fatty tissue and small numbers of lymphocytes and macrophages are present. No eosinophils or multinuclear giant cells. No signs of myocyte necrosis or apoptosis. Endocardium normal (not shown). Hematoxylin and eosin stain. (B)–(E) Immunohistochemical examination including digital imaging analysis in other biopsies displays increase of T‐lymphocytes (CD3 32 cells/mm2, B), LFA‐1 positive cells (LFA‐1 187 cells/mm2, C), and macrophages (MAC‐1 468 cells/mm2, D), but no multinuclear giant cells and no cytotoxic perforin‐positive cells (E). Positive cells are stained by brown‐red peroxidase reaction product.

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  Figure 2. Expression profiles of highly up‐regulated (A) or down‐regulated (B) myocardial genes of our patient (grey bar) compared with inflammation‐free controls (black bar) and to idiopathic giant cell myocarditis (light bar) suggested the presence of multinuclear giant cells in myocardium. All expression values of controls free of inflammation are given as 100% and the others in relation to it.