678 Rev Esp Cardiol 2002;55(6):678-81 162 Giant cell myocarditis is a rare disease of unknown ori- gin that is probably autoimmune in nature; the prognosis is poor and death often ensues unless a heart trans- plant is performed. Several cases responding to immuno- suppressive therapy have been recently reported, howe- ver. We describe a patient who developed fulminant heart failure requiring heart transplantation. Examination of the explanted heart confirmed the diagnosis of giant cell myo- carditis. Key words: Myocarditis. Heart failure. Shock. Cardiac block. Transplantation. Full English text available at: www.revespcardiol.org Miocarditis de células gigantes. Presentación de un caso La miocarditis de células gigantes (MCG) es una rara entidad, de causa desconocida, probablemente autoin- mune, de pronóstico grave, con frecuencia mortal salvo que pueda llevarse a cabo un trasplante cardíaco, si bien recientemente se han descrito casos de respuesta a tra- tamiento inmunodepresor. Presentamos un caso de un paciente que desarrolló de forma fulminante un síndrome de insuficiencia cardíaca que precisó finalmente trasplan- te cardíaco. El estudio del corazón explantado confirmó el diagnóstico de MCG. Palabras clave: Miocarditis. Insuficiencia cardíaca. Shock. Bloqueo cardíaco. Trasplante. B RIEF REPORTS Giant Cell Myocarditis. A Case Report Juan Fernández-Yáñez a , Jesús Palomo a , Patricia Muñoz c , Emilio Salinero b , Pedro Lima d and Bartolomé Vallbona e Servicios de a Cardiología, b Anatomía Patológica, c Microbiología y d Cirugía Cardíaca. Hospital General Universitario Gregorio Marañón, Madrid. e Servicio de Cardiología. Clínica Cardiológica Miramar. Palma de Mallorca. Correspondence: Dr. J. Fernández-Yáñez. Nicasio Gallego, 19, 6D. 28010. Madrid. Spain. E-mail: jyanez@jet.es. Received 8 June 2001. Accepted for publication 18 October 2001. INTRODUCTION Giant cell myocarditis (GCM) is a rare and serious illness, probably of autoimmune origin, histologically characterized by the presence of giant multinucleated cells along with extensive inflammatory infiltrates with large areas of necrosis. 1 Until 1997, barely 80 isolated cases had been published and 2 limited series. 2 In Spain, only 3 cases have been published as of the date. 3-5 We describe a case of GCM whose course required that the patient undergo cardiac transplant as the only therapeutic alternative, the definitive diagnosis being reached via the anatomical study of the explanted he- art. CLINICAL CASE 50-year-old patient, without significant clinical his- tory. Hours before admission, the patient went to his physician complaining of a sensation of dyspnea, wit- hout fever or symptoms attributable to an infectious process; he was prescribed antibiotic treatment and a bronchodilator. The night of his admission to the hos- pital he had decubitus intolerance. He went to the emergency room the following morning due to a pre- syncopal episode. Clinical and radiological findings revealed acute pulmonary edema. An ECG was perfor- med (Figure 1) that showed right branch block, ante- rior hemi block of the right branch, and 1 st degree AV block. The occurrence of a complete intermittent AV block that did not require electrical stimulation was noted. The patient was transferred to the intensive care unit and treated with diuretics, IV inotropic drugs (do- butamine), and vasodilators. Electrocardiogram sho- wed a non-dilated left ventricle (diastolic diameter 46 mm), with a severely depressed ejection fraction (25%). Catheterization with coronary angiography was performed and did not reveal significant heart disease, and ventriculography showed a 22% ejection fraction with severe anterolateral and diaphragmatic hypokine- Document downloaded from https://www.revespcardiol.org/, day 11/12/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from https://www.revespcardiol.org/, day 11/12/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.