Giant Cell Myocarditis Presenting With Cardiogenic Shock: Diagnostic and Therapeutic Challenges

Stefano H. Byer; Ibrahim Mortada; Mohammed Mhanna; Madalyn E. Walsh; Michael Arustamyan; Pavida Pachariyanon; Kathryn Eschbacher; Shareef Mansour

doi:10.1016/j.jaccas.2025.103859

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Giant Cell Myocarditis Presenting With Cardiogenic Shock: Diagnostic and Therapeutic Challenges

Journal article

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Giant Cell Myocarditis Presenting With Cardiogenic Shock: Diagnostic and Therapeutic Challenges

Stefano H. Byer, Ibrahim Mortada, Mohammed Mhanna, Madalyn E. Walsh, Michael Arustamyan, Pavida Pachariyanon, Kathryn Eschbacher and Shareef Mansour

JACC. Case reports, Vol.30(17), 103859

07/02/2025

DOI: 10.1016/j.jaccas.2025.103859

PMCID: PMC12441243

PMID: 40615209

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Abstract

Giant cell myocarditis (GCM) is a rare but often fatal inflammatory cardiomyopathy characterized by aggressive myocardial inflammation and necrosis. Prompt recognition and immunosuppressive therapy are critical for improving outcomes. A 48-year-old woman with no prior cardiac history presented with dyspnea, orthopnea, and hypotension. Electrocardiography showed wide complex tachycardia with retrograde V-to-A conduction. Laboratory findings revealed rising high-sensitivity troponin, hepatic injury, and leukocytosis. Echocardiography showed biventricular failure, and cardiac magnetic resonance imaging showed myocardial edema and subepicardial enhancement. Endomyocardial biopsy confirmed GCM. Immunosuppressive therapy with corticosteroids, tacrolimus, and mycophenolate mofetil led to clinical improvement, avoiding transplantation. GCM remains a diagnostic and therapeutic challenge due to its rapid progression and arrhythmic burden. This case highlights the importance of early biopsy, tailored immunosuppression, and vigilant monitoring in managing fulminant myocarditis.

Immunosuppression

endomyocardial biopsy

giant cell myocarditis

Details

Title: Subtitle: Giant Cell Myocarditis Presenting With Cardiogenic Shock: Diagnostic and Therapeutic Challenges
Creators: Stefano H. Byer - University of Iowa
Ibrahim Mortada - University of Iowa
Mohammed Mhanna - University of Iowa
Madalyn E. Walsh - University of Iowa
Michael Arustamyan - University of Iowa
Pavida Pachariyanon - University of Iowa
Kathryn Eschbacher - University of Iowa
Shareef Mansour - University of Iowa
Resource Type: Journal article
Publication Details: JACC. Case reports, Vol.30(17), 103859
DOI: 10.1016/j.jaccas.2025.103859
PMID: 40615209
PMCID: PMC12441243
NLM abbreviation: JACC Case Rep
ISSN: 2666-0849
eISSN: 2666-0849
Language: English
Date published: 07/02/2025
Academic Unit: Pathology; Internal Medicine
Record Identifier: 9984833485202771

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