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Recurrent Heart Failure From Fulminant Giant Cell Myocarditis Following COVID-19 Infection Requiring Heart

Alan Amedi1, Jay N Patel2, Zachary Brennan1

  • 1Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

JACC. Case Reports
|August 15, 2025
PubMed

Insights

Giant cell myocarditis (GCM) is a rare, aggressive heart condition. Early diagnosis and treatment, including mechanical support, are crucial for improving outcomes in patients with this severe form of myocarditis.

Area of Science:

  • Cardiology
  • Immunology
  • Pathology

Background:

  • Giant cell myocarditis (GCM) is a rare, rapidly progressive inflammatory cardiomyopathy.
  • Characterized by T cell-mediated myocardial destruction, GCM presents diagnostic challenges and poor outcomes without prompt intervention.

Observation:

  • A 46-year-old woman with recent COVID-19 developed flulike symptoms and dyspnea, rapidly progressing to cardiogenic shock.
  • Mechanical circulatory support with venoarterial extracorporeal membrane oxygenation was initiated.
  • Endomyocardial biopsy confirmed fulminant necrotizing myocarditis, leading to immunosuppressive therapy.

Findings:

  • Despite initial treatment and discharge, the patient experienced recurrent shock, necessitating reinitiation of mechanical support.
  • Orthotopic heart transplantation was ultimately performed.
  • Explanted heart pathology definitively diagnosed Giant Cell Myocarditis.

Implications:

  • GCM can mimic other myocarditis presentations, highlighting the necessity of endomyocardial biopsy for accurate diagnosis.
  • This case emphasizes the potential for a fulminant clinical course in GCM.
  • Early recognition, aggressive immunosuppression, and timely mechanical support are vital for managing GCM.
Abstract

Keywords:
acute heart failurecardiac assist devicescardiac transplantation

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