Myocarditis with Advanced Atrioventricular Block after Allogeneic Stem Cell Transplantation: A Case Report and Literature Review

Sumi, Masahiko; Kitahara, Mari; Shishido, Tsutomu; Kazumoto, Hiroko; Uematsu, Nozomu; Kirihara, Takehiko; Sato, Keijiro; Ueki, Tomoyuki; Hiroshima, Yukihiko; Shimizu, Kunihiko; Kobayashi, Hikaru

doi:10.2169/internalmedicine.3322-19

Cited by 3 publications

(2 citation statements)

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“…Although the precise mechanism by which these immune cells cause myocyte destruction remains unclear, the association of GCM with other systemic autoimmune processes like inflammatory bowel disease, fibromyalgia, and Hashimoto's thyroiditis emphasizes the significance of autoimmunity in the pathogenesis of the disease [ 18 , 19 ]. Cases of GCM have been reported after the use of checkpoint inhibitor immunotherapy given for the treatment of metastatic melanoma and after allogeneic hematopoietic stem cell transplants, making its etiology a complex multifactorial process involving genetics and autoimmunity [ 18 , 20 , 21 ].…”

Section: Reviewmentioning

confidence: 99%

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Immunomodulatory Therapy for Giant Cell Myocarditis: A Narrative Review

Naseeb,

Adedara,

Haseeb

et al. 2023

Cureus

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Giant cell myocarditis (GCM) is a rare, often rapidly progressive, and potentially fatal disease because of myocardium inflammation due to the infiltration of giant cells triggered by infectious as well as non-infectious etiologies. Several studies have reported that GCM can occur in patients of all ages but is more commonly found in adults. It is relatively more common among African American and Hispanic patients than in the White population. Early diagnosis and treatment are critical. Electrocardiogram (EKG), complete blood count, erythrocyte sedimentation rate, C-reactive protein, and cardiac biomarkers such as troponin and brain natriuretic peptide (BNP), echocardiogram, cardiac magnetic resonance imaging (MRI), myocardial biopsy, and myocardial gene profiling are useful diagnostic tools. Current research has identified several potential biomarkers for GCM, including myocarditis-associated immune cells, cytokines, and other chemicals. The standard of care for GCM includes aggressive immunosuppressive therapy with corticosteroids and immunomodulatory agents like rituximab, cyclosporine, and infliximab, which have shown promising results in GCM by balancing the immune system and preventing the attack on healthy tissues, resulting in the reduction of inflammation, promotion of healing, and decreasing the necessity for cardiac transplantation. Without immunosuppression, the chance of mortality or cardiac surgery was 100%. Multiple studies have revealed that a treatment combination of corticosteroids and immunomodulatory agents is superior to corticosteroids alone. Combination therapy significantly increased transplant-free survival (TFS) and decreased the likelihood of heart transplantation, hence improving overall survival. It is important to balance the benefits of immunosuppression with its potentially adverse effects. In conclusion, immunomodulatory therapy adds significant long-term survival benefits to GCM.

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Section: Reviewmentioning

confidence: 99%

“…If no infectious organisms are found on an endomyocardial biopsy (EMB) and all other known causes are ruled out, the myocarditis is autoimmune. Autoimmune illnesses, such as systemic lupus erythematosus, can cause extracardiac organ involvement, which can result in autoimmune myocarditis [20][21][22][23][24][25][26].…”

Section: Subtypes Of Myocarditismentioning

confidence: 99%