Giant Cell Myocarditis: Case Report and a Brief Review of the Literature

Abstract

Giant cell myocarditis (GCM) is an uncommon, aggressive form of inflammatory myocardial disease characterized by abundant multinucleated giant cells infiltrating the myocardium. GCM is a rare disease that can be fatal within months of diagnosis. Early diagnosis and effective management strategies that reduce inflammation and improve ejection fraction (EF) are essential for managing patients with GCM. Failure to adequately support these patients often results in further decompensation. Atrial fibrillation and a raised brain natriuretic peptide (BNP) suggest rapid decompensation and urgent management is required to reduce tachycardia-related cardiomyopathy and pulmonary congestion. Elderly patients presenting with rapid acute decompensated heart failure (ADHF) are not always investigated for a possible GCM, as the rapid deterioration is thought to be due to aging. However, this case demonstrates the importance of investigation even in older age. We present a case of a previously healthy 71-year-old female who presented with profound acute onset biventricular cardiac failure and refractory pulmonary edema and, finally, a diagnosis of GCM. We present the clinical presentation, investigation, management, and outcome. We also review the relevant literature on this serious condition.