Giant cell myocarditis treated with long-term multi-modal care with multiple mechanical circulatory support: case...

We report the case of a 71-year-old woman with giant cell myocarditis presenting as acute heart failure and cardiogenic shock (LVEF 15%). She required mechanical ventilation, IMPELLA CP (Abiomed, Danvers, MA), veno-arterial extracorporeal (VA-ECMO), and continuous renal replacement therapy. Endomyocardial biopsy confirmed giant cell myocarditis, and treatment with corticosteroids, mycophenolate mofetil, and tacrolimus was initiated. Following multi-modal support and immunosuppressive therapy, left ventricular function recovered to 54%, allowing withdrawal of mechanical circulatory support and hemodialysis. However, the patient ultimately died on the 111th day due to the long treatment of cytomegalovirus infection and septic shock from catheter-related blood stream infection. Optimal immunosuppressive regimens remain undefined, so this case highlights successful recovery of cardiac function with intensive multi-modal management.