[Diplopia and cardiogenic shock]

Area of Science:

• Cardiology
• Immunology
• Ophthalmology

Background:

• Idiopathic giant cell myocarditis (IGCM) is a rare and aggressive inflammatory heart disease.
• IGCM often presents with severe symptoms like congestive heart failure or ventricular arrhythmias.
• It is frequently associated with other systemic autoimmune disorders.

Observation:

• A case of a 39-year-old woman with initial symptoms of orbital myositis (diplopia, painful eye movements) is presented.
• The patient rapidly developed severe congestive heart failure attributed to giant cell myocarditis.
• The disease followed a fatal course within weeks, confirmed by autopsy.

Findings:

• The autopsy confirmed co-occurrence of orbital myositis and giant cell myocarditis.
• This case highlights the potential link between ocular and cardiac inflammatory processes.
• Rapid progression of cardiac dysfunction was a key feature.

Implications:

• Early and consistent cardiac function monitoring is vital for patients diagnosed with or suspected of having orbital myositis.
• Prompt cardiac evaluation may facilitate timely consideration for cardiac transplantation, the primary effective treatment for IGCM.
• This case underscores the need for a high index of suspicion for cardiac involvement in patients presenting with orbital myositis.