[An autopsied case of giant cell myocarditis and myositis associated with invasive thymoma]

A 75-year-old man was given a diagnosis of invasive thymoma (WHO type B3, stage IVa) in 2004. He received 8 cycles of chemotherapy with doxorubicin, vincristin, cyclophosphamide and cisplatin from November 2004 to May 2005, combined thoracic radiotherapy (total dosage 60 Gy) in April 2006, and 2 cycles of chemotherapy with carboplatin and paclitaxel from July 2008 to August 2008. He was readmitted to our hospital complaining of fever and neck pain in September 2008. Laboratory data on admission revealed elevated serum levels of CRP, GOT, GPT, LDH, CK, and troponin-I with hypo gamma-globulinemia. Although he received immunoglobulin and antibiotic therapy, he suddenly died of cardiac shock on the 9th hospital day. On postmortem examination of the myocardium, the skeletal muscles of the neck and iliopsoas muscle showed inflammatory cell infiltration containing multinucleated giant cells with degeneration and necrosis of the muscle tissues. These findings were consistent with giant cell myocarditis with polymyositis. Autopsy findings suggested that sudden death was caused by giant cell myocarditis, probably associated with invasive thymoma.