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Rasmussen TB, Dalager S, Andersen NH, et al. Fatal giant cell myocarditis in a patient with multiple autoimmune disorders. BMJ Case Rep. 2009;2009doi: 10.1136/bcr.09.2008.0997.
Rasmussen, T. B., Dalager, S., Andersen, N. H., Hansen, T. K., & Nielsen-Kudsk, J. E. (2009). Fatal giant cell myocarditis in a patient with multiple autoimmune disorders. BMJ case reports, 2009. https://doi.org/10.1136/bcr.09.2008.0997
Rasmussen, Torsten Bloch, et al. "Fatal giant cell myocarditis in a patient with multiple autoimmune disorders." BMJ case reports vol. 2009 (2009). doi: https://doi.org/10.1136/bcr.09.2008.0997
Rasmussen TB, Dalager S, Andersen NH, Hansen TK, Nielsen-Kudsk JE. Fatal giant cell myocarditis in a patient with multiple autoimmune disorders. BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.09.2008.0997. Epub 2009 Apr 28. PMID: 21686515; PMCID: PMC3029067.
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BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.09.2008.0997. Epub 2009 Apr 28.

Fatal giant cell myocarditis in a patient with multiple autoimmune disorders.

BMJ case reports

Torsten Bloch Rasmussen, Soren Dalager, Niels Holmark Andersen, Troels Krarup Hansen, Jens Erik Nielsen-Kudsk

Affiliations

  1. Aarhus University Hospital, Dept. of Cardiology B, Brendstrupgaardsvej 100, Aarhus, DK-8200 N, Denmark.

PMID: 21686515 PMCID: PMC3029067 DOI: 10.1136/bcr.09.2008.0997

Abstract

A case of circulatory collapse due to severe heart failure is reported in a 52-year old male with autoimmune disorders in the form of type-1 diabetes, Graves' disease and total alopecia.Upon admission, the patient had severe heart failure with a cardiac index of 0.9 l/min/m(2), a mixed venous saturation of 29% and left ventricular ejection fraction of 5%. The condition was refractory to treatment with inotropic agents and required mechanical cardiopulmonary support. Endomyocardial biopsies revealed extensive giant cell myocarditis (GCM). Immunosuppressant treatment did not alter the condition and urgent orthotopic heart transplantation was performed.Histopathological examination of the explanted heart confirmed the diagnosis and showed widespread vascular deposition of complement C4d suggesting a pathogenic role for the innate immune system in GCM.At 1-year follow-up the patient was in New York Heart Association (NYHA) class I, had episodes of sustained ventricular tachycardia but showed no evidence of GCM recurrence in endomyocardial biopsies.

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