Case ReportGiant Cell Myocarditis in a 12-Year-Old Girl With Common Variable Immunodeficiency
Section snippets
REPORT OF A CASE
A 12-year-old girl with a history of CVID presented to the emergency department after 3 days of fatigue, chest pain, mild exertional dyspnea, and an episode of near-syncope while showering. No viral prodrome had been noted. She was tachycardic with a heart rate of 150 beats/min, her blood pressure was 90/54 mm Hg, and she had an oxygen saturation of 99% by pulse oximetry. Findings on physical examination were remarkable for hepatomegaly and a third heart sound. Electrocardiography revealed
PATHOLOGIC FINDINGS
The initial endomyocardial biopsy confirmed the diagnosis of diffuse acute myocarditis, with a marked mixed inflammatory infiltrate of lymphocytes, eosinophils, and histiocytes associated with extensive myocyte damage and necrosis. Eosinophils were numerous and formed small focal cellular aggregates. The cardiectomy specimen exhibited a softened myocardium with increased thickness of the ventricular walls. On cut section, the myocardium appeared mottled with widespread light tan nodules
DISCUSSION
Giant cell myocarditis is an often fulminant form of myocardial inflammation with a high mortality rate. Most re ported cases have occurred in adults. The largest series described 63 patients ranging in age from 15 to 69 years (median, 43 years), with equal incidence in males and females.1 Although rare, GCM accounted for 22% of all cases of biopsy-verified myocarditis diagnosed at 1 major academic center during a 13 72-year period.3 No data are available about the epidemiology of GCM in
CONCLUSION
To our knowledge, this is the first case of GCM reported in a patient with CVID, and this patient is one of the youngest described with GCM. Since both disorders are thought to represent disordered T-cell function and have been encountered with similar autoimmune conditions, it may be that their association in this case reflects an underlying pathophysiologic connection. Confirmation of this hypothesis will require the identification of other examples of the association of these 2 disorders and
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Idiopathic giant cell myocarditis in childhood: A case report
2016, Legal MedicineCitation Excerpt :Giant cell myocarditis (GCM) is an uncommon and mostly fatal disease with unknown origin [1].
Myocarditis in Children
2010, Heart Failure ClinicsCitation Excerpt :Approximately 10% to 12% of adult patients with cardiomyopathy of recent onset who undergo early endomyocardial biopsy (EMB) have this condition but higher numbers have been reported for children.3 In rare cases, mutinucleated giant cells or eosinophils dominate the active inflammatory process although these rare conditions are frequently less detected than in adults (see Fig. 1).4–7 The term chronic active myocarditis histologically describes a persistent active myocarditis more than 3 months after onset of acute symptoms or detected in follow-up biopsies.3,7,8
Mechanical assist and transplantation for treatment of giant cell myocarditis
2010, Canadian Journal of CardiologyCardiac transplantation for pediatric giant cell myocarditis
2006, Journal of Heart and Lung TransplantationCase report: Myocarditis in congenital STAT1 gain-of function
2023, Frontiers in ImmunologyCardiogenic shock among cancer patients
2022, Frontiers in Cardiovascular Medicine
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The Children's Hospital and Harvard Medical School, Boston, Mass.
- 1
Mr Laufs, a medical student at the Medical University of Lübeck, Germany, contributed to this work while participating in a student clerkship.