The case of fulminant granulomatous myocarditis.

Authors

  • I. V. Hritsyna Львівський національний медичний університет імені Данила Галицького, Ukraine

DOI:

https://doi.org/10.26641/1997-9665.2014.1.35-39

Keywords:

granulomatous myocarditis, giant cell myocarditis, substitutive myocardial sclerosis, cardiogenic shock

Abstract

Background. Granulomatous myocarditis is one of the mysterious diseases: it occurs extremely rare, clinical signs and symptoms are often absent, it manifested suddenly, unexpectedly by symptoms of acute heart failure, cardiogenic shock or ventricular arrhythmia, usually finished fatally for a short period of time. The etiology and pathogenesis of this disease are unknown. Objective. The purpose of the investigation is to show the clinical course and pathological features of granulomatous myocarditis and its clinical-morphological correlations. Methods. The clinical course and anamnesis of the case were retrospectively analyzed. The data of the postmortem examination was examined in details. Results. We presented a case of idiopathic granulomatous myocarditis with fulminant onset and fatal outcome in 54-year-old man. The disease began suddenly with signs of cardiogenic shock, which was regarded as the debut of myocardial infarction. Despite the intensive care, open chest cardiac massage and artificial circulation patient died soon. Autopsy revealed extensive granulomatous myocarditis with involvement of all parts of the heart, interstitial sclerosis and left ventricle hypertrophy. Antemortal clinical signs of the disease were not observed. Conclusion. Sudden unexpected debut with hyperacute progression and rapid death in previously completely health middle-aged man are typical characteristics of this disease. Multiple foci of substitutive myocardial sclerosis are results of healed granulomas and evidences of chronic course of the disease. It remains unclear why preexisting granulomas had never manifested in the past. Extension and degree of myocardium injury does not coincide with fulminant course of the disease. The cause of the myocarditis as well as the factor which provoked exacerbation of the disease remained uncertain.

References

  1. Saltykow S. Ueber diffuse Myokarditis. Virchows Arch Pathol Anat Berl. 1905;182:1-39.
  2. Miller J. Granulomatous myocarditis. Can Med Assoc J. Aug 1933;29(2): 134–137. Cited in: PubMed; PMCID: PMC402959.
  3. Cooper LT Jr, Berry GJ, Shabetai R. Idiopathic giant-cell myocarditis – natural history and treatment. Multicenter Giant Cell Myocarditis Study Group Investigators. N Engl J Med. 1997; Jun 26;336(26):1860-6. Cited in: PubMed; PMID: 9197214.
  4. Shields RC, Tazelaar HD, Berry GJ, Cooper LT Jr. The role of right ventricular endomyocardial biopsy for idiopathic giant cell myocarditis. J Card Fail. 2002; Apr;8(2):74-8. Cited in: PubMed; PMID: 12016630.
  5. Meyer T, Grumbach IM, Kreuzer H, Morguet AJ. Giant cell myocarditis due to coxsackie B2 virus infection. Cardiology. 1997; May-Jun;88(3):296-9. Cited in: PubMed; PMID: 9129853.
  6. Adachi Y, Yasumizu R, Hashimoto F, Otsuka Y, Okamura A, Kato Y, Oyaizu H, Ikebukuro K, Fukuhara S, Nakai Y, Ikehara S. An autopsy case of giant cell myocarditis probably due to a non-steroidal anti-inflammatory drug. Pathol Int. 2001 Feb;51(2):113-7. Cited in: PubMed; PMID: 11169150.
  7. de Jongste MJ, Oosterhuis HJ, Lie KI. Intractable ventricular tachycardia in a patient with giant cell myocarditis, thymoma and myasthenia gravis. Int J Cardiol. 1986; Dec;13(3):374-8. Cited in: PubMed; PMID: 3793292.
  8. Koul D, Kanwar M, Jefic D, Kolluru A, Singh T, Dhar S, Kumar P, Cohen G. Fulminant giant cell myocarditis and cardiogenic shock: an unusual presentation of malignant thymoma. Cardiol Res Pract. 2010; 2010:185896. doi: 10.4061/2010/185896. Epub 2010 May 4. Cited in: PubMed; PMID: 20454573; PMCID: PMC2864446
  9. Cooper LT Jr. Giant cell myocarditis: diagnosis and treatment. Herz. 2000 May;25(3):291-8. Cited in: PubMed; PMID: 10904855.
  10. Kodama M, Matsumoto Y, Fujiwara M, Masani F, Izumi T, Shibata A. A novel experimental model of giant cell myocarditis induced in rats by immunization with cardiac myosin fraction. Clin Immunol Immunopathol. 1990; Nov;57(2):250-62. Cited in: PubMed; PMID: 2208806.
  11. Parrish JA. Fiedler’s myocarditis. Br Heart J. 1965 May;27:458-61. Cited in: PubMed; PMID: 14284367; PMCID: PMC503332.
  12. Long WH. Granulomatous (Fiedler's) myocarditis with extracardiac involvement. A case report with sudden death. 1961 Jul 22;177:184-6. Cited in: PubMed; PMID: 13763345.
  13. Bogabathina H, Olson P, Rathi VK, Biederman RW. Cardiac sarcoidosis or giant cell myocarditis? On treatment improvement of fulminant myocarditis as demonstrated by cardiovascular magnetic resonance imaging. Case Reports in Cardiology. 2012 Jan;2012: 5 pages. doi 10.1155/2012/647041.

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How to Cite

Hritsyna, I. V. (2014). The case of fulminant granulomatous myocarditis. Морфологія / Morphologia / Morfologìâ, 8(1), 35–39. https://doi.org/10.26641/1997-9665.2014.1.35-39

Issue

Vol. 8 No. 1 (2014)

Section

Статті

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