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Giant cell myocarditis masquerading as orbital myositis with a rapid, fulminant course necessitating mechanical

Vinisha Garg1, Weiyi Tan1, Reza Ardehali1

  • 1Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, CA, 90095, USA.

ESC Heart Failure
|August 4, 2017
PubMed

Insights

Giant cell myocarditis (GCM) can present with only ocular symptoms. This rare cardiac inflammation rapidly progressed to heart failure, requiring mechanical support and heart transplantation.

Area of Science:

  • Cardiology
  • Immunology
  • Ophthalmology

Background:

  • Giant cell myocarditis (GCM) is a rare, aggressive cardiac inflammation.
  • GCM typically presents with severe heart failure, arrhythmias, and conduction abnormalities.
  • Ocular symptoms are an uncommon initial presentation of GCM.

Observation:

  • A unique case of GCM presented solely with ocular symptoms (orbital myositis).
  • Unlike previous reports, this patient experienced rapid progression of cardiac dysfunction.
  • The patient developed fulminant heart failure, tachyarrhythmias, and conduction disease.

Findings:

  • This case highlights a distinct GCM presentation with initial ocular manifestations.
  • The disease rapidly advanced to critical cardiac compromise.
  • Successful management involved mechanical circulatory support and heart transplantation.

Implications:

  • Early recognition of GCM is crucial, even with atypical initial symptoms.
  • Ocular findings may herald rapidly progressive cardiac involvement in GCM.
  • Advanced mechanical support and transplantation can be life-saving interventions for severe GCM.

Keywords:
Endomyocardial biopsyGiant cell myocarditisHeartWare ventricular assist deviceImpella deviceOrbital myositis

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