Does treatment with cyclosporine and prednisone improve cardiac function in a patient with fulminant myocarditis with overlapping features of cardiac sarcoidosis and giant cell myocarditis?
Cyclosporine and prednisone may be effective in treating fulminant myocarditis with overlapping features of cardiac sarcoidosis and giant cell myocarditis, with recovery trackable by cardiovascular magnetic resonance imaging.
Giant cell myocarditis, but not cardiac sarcoidosis, is known to cause fulminant myocarditis resulting in severe heart failure. However, giant cell myocarditis and cardiac sarcoidosis are pathologically similar, and attempts at pathological differentiation between the two remain difficult. We are presenting a case of fulminant myocarditis that has pathological features suggestive of cardiac sarcoidosis, but clinically mimicking giant cell myocarditis. This patient was treated with cyclosporine and prednisone and recovered well. This case we believe challenges our current understanding of these intertwined conditions. By obtaining a sense of severity of cardiac involvement via delayed hyperenhancement of cardiac magnetic resonance imaging, we were more inclined to treat this patient as giant cell myocarditis with cyclosporine. This resulted in excellent improvement of patient's cardiac function as shown by delayed hyperenhancement images, early perfusion images, and SSFP videos.
Bogabathina et al. (Sun,) studied this question.