Abstract
A 45-year-old woman with no medical history underwent pacemaker implantation for a
symptomatic complete atrioventricular block. On day 6, she noticed diplopia and then
fever, general malaise, and elevation of serum creatinine kinase (CK). She was transferred
to our hospital on day 21. Serum CK was elevated to 4543 IU/L, and echocardiography
revealed a left ventricular ejection fraction of 43 %. We diagnosed her with giant
cell myocarditis (GCM) via an emergent myocardial biopsy that revealed a proliferation
of lymphocytes, eosinophils, and giant cells without granulomas. Initial treatment
with high doses of intravenous methylprednisolone and immunoglobulin improved her
symptoms in a few days, and prednisolone was given as follow-up treatment. CK was
normalized in a week and a thinning of the interventricular septum mimicking cardiac
sarcoidosis (CS) occurred. On day 38, we added a calcineurin inhibitor, tacrolimus,
and maintained her with a combination of prednisolone and tacrolimus at a target dose
of 10–15 ng/mL. Six months after the onset, there were no signs of relapse despite
the persistent mild elevation of troponin I levels. We present a case of GCM mimicking
CS successfully maintained by a combination of two immunosuppressive agents.
Learning objective
Recommended treatment for giant cell myocarditis (GCM), a potentially fatal disease,
is a combination of three immunosuppressive agents. However, GCM shares many characteristics
with cardiac sarcoidosis (CS), which is treated using prednisolone alone in many cases.
Recent studies on GCM and CS suggest they are different spectrums of a common entity.
Although they can clinically overlap, they have different progressive speeds and severities.
We present a case of GCM mimicking CS successfully treated with a combination of two
immunosuppressive agents.
Keywords
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Article info
Publication history
Published online: February 17, 2023
Accepted:
January 31,
2023
Received in revised form:
January 7,
2023
Received:
November 16,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
