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Giant Cell Myocarditis in Children: Elusive Giant Cells Might Not Be the Only Clue

Chrystalle Katte Carreon1, Jonathon A Hagel2,3, Kevin P Daly3,4

  • 1Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.

Pediatric and Developmental Pathology : the Official Journal of the Society for Pediatric Pathology and the Paediatric Pathology Society
|October 4, 2021
PubMed

Insights

Giant cell myocarditis (GCM) is a rare, aggressive heart condition. Initial cardiac biopsies in pediatric patients often yield inconclusive results, delaying definitive diagnosis and treatment.

Area of Science:

  • Pediatric Cardiology
  • Cardiac Pathology
  • Rare Diseases

Background:

  • Giant cell myocarditis (GCM) is a severe, rapidly progressing form of fulminant myocarditis.
  • GCM has a high mortality rate, particularly in pediatric populations.
  • Diagnosis can be challenging due to atypical presentations and initial biopsy findings.

Purpose of the Study:

  • To present two pediatric cases of Giant Cell Myocarditis (GCM).
  • To highlight similarities in clinical presentation and initial cardiac biopsy findings.
  • To underscore the diagnostic challenges associated with GCM in children.

Main Methods:

  • Retrospective review of two pediatric cases diagnosed with GCM over 20 years.
  • Analysis of clinical presentations.
  • Histopathological examination of initial cardiac biopsy samples.

Main Results:

  • Only two pediatric cases of GCM were definitively diagnosed institutionally over two decades.
  • Initial cardiac biopsies in both patients were histologically similar but inconclusive for GCM.
  • Patients presented with similar clinical features, complicating early diagnosis.

Conclusions:

  • Giant cell myocarditis is rare in children, with diagnostic delays common.
  • Initial cardiac biopsies may not provide definitive GCM diagnosis, necessitating further investigation.
  • Recognizing similar clinical and initial histopathological patterns is crucial for timely GCM diagnosis in pediatric patients.

Keywords:
Omenn syndromecardiac transplantcommon variable immunodeficiencyendomyocardial biopsyfulminant myocarditisgiant cell myocarditis

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