Immunosuppressive therapy with methylprednisolone and rat antithymocyte globulin can successfully treat aggressive giant cell myocarditis presenting with cardiogenic shock and incessant ventricular arrhythmias, though opportunistic infections like tuberculosis remain a risk.
Hypothesis-generating for immunosuppression in fulminant giant cell myocarditis; prospective studies needed to confirm benefit and infection management.
Giant cell myocarditis is an aggressive form of this condition that is typically progressive and unresponsive to usual medical treatment. Here, we describe a 34-year-old patient presenting with incessant ventricular arrhythmias with hemodynamic compromise who required prolonged support in intensive care with an intra-aortic balloon pump (IABP). His Coronary arteries were normal and LV endomyocardial biopsy revealed myocyte necrosis with inflammatory infiltrate of lymphocytes, eosinophils, and giant cells suggestive of giant cell myocarditis. He was successfully treated with pulsed intravenous methylprednisolone and rat antithymocyte globulin (RATG). Despite a good functional cardiac recovery, some months later he developed a fluctuant neck swelling which fine needle aspiration confirmed as tuberculosis.
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Baig et al. (2011) studied this question.
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