Giant cell myocarditis masquerading as orbital myositis with a rapid, fulminant course necessitating mechanical support and heart transplantation

Garg, Vinisha; Tan, Weiyi; Ardehali, Reza; Shah, Janki; Huynh, Tracy; Aksoy, Olcay

doi:10.1002/ehf2.12141

Cited by 10 publications

(6 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, some patients with GCM may present with ocular symptoms ( 18 ). In the literature, a total of 10 cases of GCM with orbital myositis or other ocular symptoms have been reported ( 22 - 24 ). Orbital myositis is a nonspecific inflammatory disorder of the extraocular muscles, and is generally considered an autoimmune disease.…”

Section: Discussionmentioning

confidence: 99%

A case report of giant cell myocarditis complicated by severe heart failure: the value of early endomyocardial biopsy and mechanical circulatory support

Lunde,

Gude,

Myrmel

et al. 2023

Cardiovasc Diagn Ther

View full text Add to dashboard Cite

Background Giant cell myocarditis (GCM) is a rare, probably underdiagnosed and potentially fatal disease in young and middle-aged patients. Disease progression is often rapid, and life-threatening arrhythmias and cardiogenic shock due to progressive left ventricular failure are among the most feared complications. Although cardiac biomarkers and multimodality imaging are used as initial diagnostic tests in most patients, endomyocardial biopsy (EMB) is often required for a definitive diagnosis. However, there are still gaps in our knowledge in terms of the etiology, early diagnosis, management and prognosis of GCM. Case Description We present the case of a male patient in his early 50s admitted to Haukeland University Hospital with fulminant GCM. He had no significant medical history in the past apart from hypertension, and presented to hospital in cardiogenic shock after a few weeks of progressive shortness of breath. Rapid initiation of methylprednisolone had an immediate effect on reducing myocardial inflammation, and sustained treatment with a combination of immunosuppressive agents along with optimal heart failure medications led to complete recovery of the heart function and clinical remission over several years. The case study highlights the urgency of an early EMB, access to mechanical circulatory support (MCS) and the efficacy of immunosuppressive treatment and optimal medical management for heart failure. Finally, our review of the literature also provides an updated guidance on the contemporary management of GCM patients. Conclusions Accurate and early diagnosis with EMB in patients with GCM are crucial for better outcomes. Rapid initiation of methylprednisolone reduces myocardial inflammation and the risk of death. Sustained treatment with a combination of immunosuppressive agents together with optimal heart failure medications are essential for myocardial recovery and long-term stabilization. The use of MCS is the cornerstone in the management of GCM with a clear survival benefit.

show abstract

Section: Discussionmentioning

confidence: 99%

A case report of giant cell myocarditis complicated by severe heart failure: the value of early endomyocardial biopsy and mechanical circulatory support

Lunde,

Gude,

Myrmel

et al. 2023

Cardiovasc Diagn Ther

View full text Add to dashboard Cite

show abstract

“…8 Advantages include high flows, durability, and possibility of ambulation. Surgical approaches include Total Artificial Heart (SynCardia Systems, Inc, Tucson, AZ) and centrally cannulated, extracorporeal pumps such as CentriMag (Thoratec, Pleasanton, CA).…”

Section: Discussionmentioning

confidence: 99%

“…Durable ventricular assist devices implanted into the LV and RV as a bridge to transplantation have also been previously reported. 8 Advantages include high flows, durability, and possibility of ambulation. Disadvantages include need for sternotomy, bleeding risk, mediastinal adhesions, and prolonged intubation.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive biventricular mechanical circulatory support with Impella pumps as a bridge to heart transplantation: a first‐in‐the‐world case report

Varian

Lin

et al. 2019

ESC Heart Failure

View full text Add to dashboard Cite

Cardiogenic shock from biventricular failure that requires acute mechanical circulatory support carries high 30 day mortality. Acute mechanical circulatory support can serve as bridge to orthotopic heart transplant (OHT) in selected patients. We report a patient with biventricular failure secondary to rapidly progressive cardiac sarcoidosis refractory to medical management who was bridged to OHT with Impella 5.0 and Impella RP—temporary left and right ventricular assist devices, respectively. This is the first successful bridge to transplantation using these devices in biventricular heart failure and cardiogenic shock. We discuss considerations for using this strategy over veno‐arterial extracorporeal membrane oxygenation or surgically implanted assist devices in patients with cardiogenic shock and biventricular failure as a bridge to OHT.

show abstract

“…2 Ocular manifestations of GCM are rare and limited to case reports of orbital myositis. [3][4][5][6][7] In some cases the orbital myositis indicated the underlying disease. Few patients with GCM have had detectable anticardiac antibodies, including anticardiac myosin, which supports the…”

Section: Discussionmentioning

confidence: 99%

“…Ocular manifestations of GCM are rare and limited to case reports of orbital myositis . In some cases the orbital myositis indicated the underlying disease.…”

Section: Discussionmentioning

confidence: 99%

Choroidal Infiltrate of Unknown Cause

McKay

Sobrin

2019

JAMA Ophthalmol

View full text Add to dashboard Cite

A woman in her late 50s reported right eye visual field changes. Review of medical history revealed lumpectomy and radiotherapy for breast cancer 6 years prior. Visual acuity was 20/160 OD (her baseline due to amblyopia) and 20/20 OS. Pupillary function was normal. The anterior chamber and vitreous were quiet. Fundus photographs showed optic nerve edema and a peripapillary choroidal infiltrate in the right eye. Swept-source optical coherence tomography (OCT) demonstrated retinal thickening with cystoid abnormalities, subretinal hyperreflective material consistent with fibrosis, and choroidal thickening in the right eye (Figure 1). Optical coherence tomography of the optic nerve head in the right eye demonstrated 360°peripapillary nerve fiber thickening and diffuse nerve head elevation. Fluorescein angiography demonstrated staining with minimal leakage in the temporal peripapillary retina of the right eye.Testing results for an underlying neoplastic, inflammatory, or infectious process were unrevealing, including negative results of serology tests for tuberculosis, toxoplasmosis, syphilis, Lyme disease, and sarcoidosis. Results of complete blood cell count, serum protein electrophoresis, and bone marrow biopsy were not supportive of lymphoproliferative disease. Results of magnetic resonance imaging of the brain and orbits were normal. Computed tomographic scan of the chest, abdomen, and pelvis demonstrated no lymphadenopathy.Four months prior to presentation, routine electrocardiogram demonstrated a right bundle branch block. Eight months later, complete heart block necessitated urgent pacemaker implantation.

show abstract

Giant cell myocarditis masquerading as orbital myositis with a rapid, fulminant course necessitating mechanical support and heart transplantation

Cited by 10 publications

References 9 publications

A case report of giant cell myocarditis complicated by severe heart failure: the value of early endomyocardial biopsy and mechanical circulatory support

A case report of giant cell myocarditis complicated by severe heart failure: the value of early endomyocardial biopsy and mechanical circulatory support

Minimally invasive biventricular mechanical circulatory support with Impella pumps as a bridge to heart transplantation: a first‐in‐the‐world case report

Choroidal Infiltrate of Unknown Cause

Contact Info

Product

Resources

About