Giant cell myocarditis

The present report describes a 45-year-old man with giant cell myocarditis who died of heart failure eight months after the onset of symptoms. On postmortem examination, the heart showed extensive myocardial fibrosis with numerous multinucleated giant cells. The lungs and a series of 20 lymph nodes showed no evidence of granulomatous disease, thereby excluding a diagnosis of sarcoidosis. Circumstantial evidence supports the view that giant cell myocarditis may have an autoimmune origin, and the histopathology suggests that cellular immune mechanisms might have a role in the pathogenesis of this disease. On this basis, it is suggested that cyclosporine, a selective inhibitor of T lymphocyte-mediated immune responses, may be useful for the treatment of this presently fatal disease.